Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

Logical Model: PASMetricData - Detailed Descriptions

Page standards status: Informative Maturity Level: 1

Definitions for the PASMetricData logical model.

Guidance on how to interpret the contents of this table can be found here

0. PASMetricData
Definition

A logical model describing the information that should be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation

ShortPAS Metric Data
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. PASMetricData.source
Definition

A code to indicate which type of system collected the metric data.

Shortprovider | intermediary | payer
Control1..1
BindingThe codes SHALL be taken from Metric Data Source
(required to http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource)
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
4. PASMetricData.providerId
Definition

The NPI number of the user who initiated the PAS request.

ShortUser invoking hook
Control1..1
TypeIdentifier
6. PASMetricData.providerId.system
Pattern Valuehttp://hl7.org/fhir/sid/us-npi
8. PASMetricData.providerId.value
Control1..?
10. PASMetricData.groupId
Definition

The NPI of the hospital/clinic/other organization that initiated the PAS request.

ShortHealthcare org of user
Control1..1
TypeIdentifier
12. PASMetricData.groupId.system
Pattern Valuehttp://hl7.org/fhir/sid/us-npi
14. PASMetricData.groupId.value
Control1..?
16. PASMetricData.payerId
Definition

The identifier of the payer organization to whom the PAS call was made.

ShortPayer receiving hook
Control1..1
TypeIdentifier
18. PASMetricData.payerId.system
Control1..?
20. PASMetricData.payerId.value
Control1..?
22. PASMetricData.exchange
Definition

Exchanges between providers, intermediares, and payers to support prior authorization.

ShortPrior Authorization Exchanges
Control1..*
TypeBackboneElement
24. PASMetricData.exchange.type
Definition

A code indicating the type of exchange

Shortinitial | subsequent | cancel | update | query | initialDocToPayer
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. PASMetricData.exchange.with
Definition

The destination for the exchange

Shortprovider | intermediary | payer
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
28. PASMetricData.exchange.method
Definition

Exchange standard used for this specific exchange. Note: RESTful is the default for any Provider to Intermediary exchange, X12 is the defalt for any exchange between the intermediary and the payer for the X12 278, the exchange of the PAS bundle between the intermediary and the payer may be any of the methods included in the value set.

Shortx12 | restful | ihe | direct | other
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
30. PASMetricData.exchange.requestTime
Definition

For providers, the request was made. For payers, the time the request was received. For intermediaries time the request was received from the provider or time the request was sent to the payer.

ShortTime exchange initiated
Control1..1
Typeinstant
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
32. PASMetricData.exchange.responseTime
Definition

For providers, the response was received. For payers, the time the response was sent. For intermediaries time the response was sent to the provider or time the response was received from the payer.

ShortTime of exchange response
Control0..1
Typeinstant
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. PASMetricData.exchange.httpResponse
Definition

What HTTP response code was returned for the exchange invocation.

Shorte.g. 200
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
36. PASMetricData.issue
Definition

In the event of an HTTP error, if an OperationOutcome was returned, what were the issues.

ShortOperationOutcome info
Control0..*
TypeBackboneElement
38. PASMetricData.issue.code
Definition

The issue.code value from the OperationOutcome for this issue.

ShortError code
Control1..1
BindingThe codes SHALL be taken from IssueType
(required to http://hl7.org/fhir/ValueSet/issue-type)
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
40. PASMetricData.issue.details
Definition

The issue.details value from the OperationOutcome for this issue.

ShortMore detailed error code
Control0..1
BindingFor example codes, see OperationOutcomeCodes
(example to http://hl7.org/fhir/ValueSet/operation-outcome)
TypeCodeableConcept
42. PASMetricData.aaaCodes
Definition

Any AAA codes returned during the exchange.

ShortAAA codes returned
Control0..*
TypeBackboneElement
44. PASMetricData.aaaCodes.loopID
Definition

X12 loop ID.

Shortsee X12 loop IDs
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
46. PASMetricData.aaaCodes.aaaCode
Definition

AAA code returned with response.

Shortapproved | modified | denied
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
48. PASMetricData.itemDetail
Definition

Service level detail. One interation of the backbone for each service item in the PA exchange.

ShortService level item detail
Control0..*
TypeBackboneElement
50. PASMetricData.itemDetail.trn
Definition

Service level TRN assigned by the payer if a questionnaire is required.

ShortService Level TRN
Control0..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
52. PASMetricData.itemDetail.item
Definition

The specific procedure, item, medication, appointment, nutrition that is the subject of the order.

Shorteg. ICD10, HCPCS, NDC
Control1..1
TypeCodeableConcept
54. PASMetricData.itemDetail.assertionId
Definition

The unique ID for the order item returned by CRD in the coverage information.

ShortUnique ID for order item
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
56. PASMetricData.itemDetail.initialSubmissionTime
Definition

Date/time of the initial submission of the servcie item. This may be the time of the initial PA request or the time of an updated that added the service item.

ShortDate/time of the initial submission of the item
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
58. PASMetricData.itemDetail.finalResponseTime
Definition

Date/time that the final result was returned for the specific service item.

ShortDate/time of final result
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
60. PASMetricData.itemDetail.responsesRequired
Definition

Number of responses (initial and any with result pended) for the service item.

ShortNumber of responses
Control0..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
62. PASMetricData.itemDetail.aaaCodes
Definition

Any AAA codes returned during the exchange.

ShortAAA codes returned
Control0..*
TypeBackboneElement
64. PASMetricData.itemDetail.aaaCodes.loopID
Definition

X12 loop ID.

Shortsee X12 loop IDs
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
66. PASMetricData.itemDetail.aaaCodes.aaaCode
Definition

AAA error code returned in the response.

Shortapproved | modified | deined
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
68. PASMetricData.itemDetail.locationType
Definition

The site where the service will be performed.

Shortinpatient | outpatient | home
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
70. PASMetricData.itemDetail.result
Definition

Final result of the specific service item.

Shortapproved | modified | denied | pended
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
72. PASMetricData.itemDetail.denialReason
Definition

A code specifying the reason why the item was denied.

ShortDenial Reason
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
74. PASMetricData.supportingDoc
Definition

The URL of the questionnaire that was the basis for the questionnaireResponse submitted as part of the PAS bundle for the specific service item.

ShortDocumentation submitted as part of PAS Bundle
Control0..1
Typeurl
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
76. PASMetricData.requestedDoc
Definition

Documentation requested via 278 response.

ShortDocumentation requested via 278 response
Control0..*
TypeBackboneElement
78. PASMetricData.requestedDoc.docRequest
Definition

Coded requests for documentation in the 278 response. May be LOINC codes as determined by HIPAA tab or X12 codes from the PWK01 element.

ShortCoded requests for additional documentation
Control1..*
TypeCodeableConcept
80. PASMetricData.requestedDoc.timeRequested
Definition

Date/Time of initial request for this item (may be part of the initial submission or part an update.

ShortDate/Time of initial request
Control1..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
82. PASMetricData.requestedDoc.timeSubmitted
Definition

Date/Time of final result for this item (may be part of the initial submission or part an update.

ShortDate/Time of final result
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
84. PASMetricData.requestedDoc.submissionMethod
Definition

The technical method used to submit the requested additional documentation.

ShortCDex | portal | fax | x12 | other
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
86. PASMetricData.exceptionSubmission
Definition

Indicator that exchange was performed under an exception grant from the National Standard Group.

ShortTrue if exchange is based on the exception grant
Control0..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
88. PASMetricData.businessLine
Definition

A code that indicates which type of insurance the patient is covered by.

ShortE.g. MedicareAdvantage
Control0..1
TypeCodeableConcept

Guidance on how to interpret the contents of this table can be found here

0. PASMetricData
Definition

A logical model describing the information that should be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation

ShortPAS Metric Data
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. PASMetricData.source
Definition

A code to indicate which type of system collected the metric data.

Shortprovider | intermediary | payer
Control1..1
BindingThe codes SHALL be taken from Metric Data Source
(required to http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource)
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
4. PASMetricData.providerId
Definition

The NPI number of the user who initiated the PAS request.

ShortUser invoking hook
Control1..1
TypeIdentifier
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. PASMetricData.providerId.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. PASMetricData.providerId.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Pattern Valuehttp://hl7.org/fhir/sid/us-npi
Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. PASMetricData.providerId.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. PASMetricData.groupId
Definition

The NPI of the hospital/clinic/other organization that initiated the PAS request.

ShortHealthcare org of user
Control1..1
TypeIdentifier
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. PASMetricData.groupId.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. PASMetricData.groupId.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Pattern Valuehttp://hl7.org/fhir/sid/us-npi
Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. PASMetricData.groupId.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. PASMetricData.payerId
Definition

The identifier of the payer organization to whom the PAS call was made.

ShortPayer receiving hook
Control1..1
TypeIdentifier
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. PASMetricData.payerId.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. PASMetricData.payerId.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control10..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. PASMetricData.payerId.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Example<br/><b>General</b>:123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. PASMetricData.exchange
Definition

Exchanges between providers, intermediares, and payers to support prior authorization.

ShortPrior Authorization Exchanges
Control1..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. PASMetricData.exchange.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
32. PASMetricData.exchange.type
Definition

A code indicating the type of exchange

Shortinitial | subsequent | cancel | update | query | initialDocToPayer
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
34. PASMetricData.exchange.with
Definition

The destination for the exchange

Shortprovider | intermediary | payer
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
36. PASMetricData.exchange.method
Definition

Exchange standard used for this specific exchange. Note: RESTful is the default for any Provider to Intermediary exchange, X12 is the defalt for any exchange between the intermediary and the payer for the X12 278, the exchange of the PAS bundle between the intermediary and the payer may be any of the methods included in the value set.

Shortx12 | restful | ihe | direct | other
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
38. PASMetricData.exchange.requestTime
Definition

For providers, the request was made. For payers, the time the request was received. For intermediaries time the request was received from the provider or time the request was sent to the payer.

ShortTime exchange initiated
Control1..1
Typeinstant
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
40. PASMetricData.exchange.responseTime
Definition

For providers, the response was received. For payers, the time the response was sent. For intermediaries time the response was sent to the provider or time the response was received from the payer.

ShortTime of exchange response
Control0..1
Typeinstant
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
42. PASMetricData.exchange.httpResponse
Definition

What HTTP response code was returned for the exchange invocation.

Shorte.g. 200
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
44. PASMetricData.issue
Definition

In the event of an HTTP error, if an OperationOutcome was returned, what were the issues.

ShortOperationOutcome info
Control0..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. PASMetricData.issue.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
48. PASMetricData.issue.code
Definition

The issue.code value from the OperationOutcome for this issue.

ShortError code
Control1..1
BindingThe codes SHALL be taken from IssueType
(required to http://hl7.org/fhir/ValueSet/issue-type)
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
50. PASMetricData.issue.details
Definition

The issue.details value from the OperationOutcome for this issue.

ShortMore detailed error code
Control0..1
BindingFor example codes, see OperationOutcomeCodes
(example to http://hl7.org/fhir/ValueSet/operation-outcome)
TypeCodeableConcept
52. PASMetricData.aaaCodes
Definition

Any AAA codes returned during the exchange.

ShortAAA codes returned
Control0..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. PASMetricData.aaaCodes.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
56. PASMetricData.aaaCodes.loopID
Definition

X12 loop ID.

Shortsee X12 loop IDs
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
58. PASMetricData.aaaCodes.aaaCode
Definition

AAA code returned with response.

Shortapproved | modified | denied
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
60. PASMetricData.itemDetail
Definition

Service level detail. One interation of the backbone for each service item in the PA exchange.

ShortService level item detail
Control0..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
62. PASMetricData.itemDetail.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
64. PASMetricData.itemDetail.trn
Definition

Service level TRN assigned by the payer if a questionnaire is required.

ShortService Level TRN
Control0..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
66. PASMetricData.itemDetail.item
Definition

The specific procedure, item, medication, appointment, nutrition that is the subject of the order.

Shorteg. ICD10, HCPCS, NDC
Control1..1
TypeCodeableConcept
68. PASMetricData.itemDetail.assertionId
Definition

The unique ID for the order item returned by CRD in the coverage information.

ShortUnique ID for order item
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
70. PASMetricData.itemDetail.initialSubmissionTime
Definition

Date/time of the initial submission of the servcie item. This may be the time of the initial PA request or the time of an updated that added the service item.

ShortDate/time of the initial submission of the item
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
72. PASMetricData.itemDetail.finalResponseTime
Definition

Date/time that the final result was returned for the specific service item.

ShortDate/time of final result
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
74. PASMetricData.itemDetail.responsesRequired
Definition

Number of responses (initial and any with result pended) for the service item.

ShortNumber of responses
Control0..1
Typeinteger
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
76. PASMetricData.itemDetail.aaaCodes
Definition

Any AAA codes returned during the exchange.

ShortAAA codes returned
Control0..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. PASMetricData.itemDetail.aaaCodes.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
80. PASMetricData.itemDetail.aaaCodes.loopID
Definition

X12 loop ID.

Shortsee X12 loop IDs
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
82. PASMetricData.itemDetail.aaaCodes.aaaCode
Definition

AAA error code returned in the response.

Shortapproved | modified | deined
Control1..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
84. PASMetricData.itemDetail.locationType
Definition

The site where the service will be performed.

Shortinpatient | outpatient | home
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
86. PASMetricData.itemDetail.result
Definition

Final result of the specific service item.

Shortapproved | modified | denied | pended
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
88. PASMetricData.itemDetail.denialReason
Definition

A code specifying the reason why the item was denied.

ShortDenial Reason
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
90. PASMetricData.supportingDoc
Definition

The URL of the questionnaire that was the basis for the questionnaireResponse submitted as part of the PAS bundle for the specific service item.

ShortDocumentation submitted as part of PAS Bundle
Control0..1
Typeurl
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
92. PASMetricData.requestedDoc
Definition

Documentation requested via 278 response.

ShortDocumentation requested via 278 response
Control0..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
94. PASMetricData.requestedDoc.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
96. PASMetricData.requestedDoc.docRequest
Definition

Coded requests for documentation in the 278 response. May be LOINC codes as determined by HIPAA tab or X12 codes from the PWK01 element.

ShortCoded requests for additional documentation
Control1..*
TypeCodeableConcept
98. PASMetricData.requestedDoc.timeRequested
Definition

Date/Time of initial request for this item (may be part of the initial submission or part an update.

ShortDate/Time of initial request
Control1..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
100. PASMetricData.requestedDoc.timeSubmitted
Definition

Date/Time of final result for this item (may be part of the initial submission or part an update.

ShortDate/Time of final result
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
102. PASMetricData.requestedDoc.submissionMethod
Definition

The technical method used to submit the requested additional documentation.

ShortCDex | portal | fax | x12 | other
Control0..1
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
104. PASMetricData.exceptionSubmission
Definition

Indicator that exchange was performed under an exception grant from the National Standard Group.

ShortTrue if exchange is based on the exception grant
Control0..1
Typeboolean
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
106. PASMetricData.businessLine
Definition

A code that indicates which type of insurance the patient is covered by.

ShortE.g. MedicareAdvantage
Control0..1
TypeCodeableConcept

Guidance on how to interpret the contents of this table can be found here

0. PASMetricData
Definition

A logical model describing the information that should be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation

ShortPAS Metric Data
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. PASMetricData.source
Definition

A code to indicate which type of system collected the metric data.

Shortprovider | intermediary | payer
Control1..1
BindingThe codes SHALL be taken from Metric Data Source
(required to http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource)
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
4. PASMetricData.providerId
Definition

The NPI number of the user who initiated the PAS request.

ShortUser invoking hook
Control1..1
TypeIdentifier
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. PASMetricData.providerId.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
8. PASMetricData.providerId.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on PASMetricData.providerId.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 10. PASMetricData.providerId.use
    Definition

    The purpose of this identifier.

    Shortusual | official | temp | secondary | old (If known)
    Comments

    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

    Control0..1
    BindingThe codes SHALL be taken from IdentifierUse
    (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

    Identifies the purpose for this identifier, if known .

    Typecode
    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. PASMetricData.providerId.type
    Definition

    A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

    ShortDescription of identifier
    Comments

    This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
    (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

    A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

    Allows users to make use of identifiers when the identifier system is not known.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. PASMetricData.providerId.system
    Definition

    Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

    ShortThe namespace for the identifier value
    Comments

    Identifier.system is always case sensitive.

    Control0..1
    Typeuri
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

    Pattern Valuehttp://hl7.org/fhir/sid/us-npi
    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. PASMetricData.providerId.value
    Definition

    The portion of the identifier typically relevant to the user and which is unique within the context of the system.

    ShortThe value that is unique
    Comments

    If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

    Control1..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Example<br/><b>General</b>:123456
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. PASMetricData.providerId.period
    Definition

    Time period during which identifier is/was valid for use.

    ShortTime period when id is/was valid for use
    Control0..1
    TypePeriod
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. PASMetricData.providerId.assigner
    Definition

    Organization that issued/manages the identifier.

    ShortOrganization that issued id (may be just text)
    Comments

    The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

    Control0..1
    TypeReference(Organization)
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. PASMetricData.groupId
    Definition

    The NPI of the hospital/clinic/other organization that initiated the PAS request.

    ShortHealthcare org of user
    Control1..1
    TypeIdentifier
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. PASMetricData.groupId.id
    Definition

    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

    ShortUnique id for inter-element referencing
    Control0..1
    Typestring
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    26. PASMetricData.groupId.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on PASMetricData.groupId.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 28. PASMetricData.groupId.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUse
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. PASMetricData.groupId.type
      Definition

      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

      ShortDescription of identifier
      Comments

      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows users to make use of identifiers when the identifier system is not known.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. PASMetricData.groupId.system
      Definition

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

      Control0..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      Pattern Valuehttp://hl7.org/fhir/sid/us-npi
      Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. PASMetricData.groupId.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control1..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Example<br/><b>General</b>:123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. PASMetricData.groupId.period
      Definition

      Time period during which identifier is/was valid for use.

      ShortTime period when id is/was valid for use
      Control0..1
      TypePeriod
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. PASMetricData.groupId.assigner
      Definition

      Organization that issued/manages the identifier.

      ShortOrganization that issued id (may be just text)
      Comments

      The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

      Control0..1
      TypeReference(Organization)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. PASMetricData.payerId
      Definition

      The identifier of the payer organization to whom the PAS call was made.

      ShortPayer receiving hook
      Control1..1
      TypeIdentifier
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. PASMetricData.payerId.id
      Definition

      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      44. PASMetricData.payerId.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on PASMetricData.payerId.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 46. PASMetricData.payerId.use
        Definition

        The purpose of this identifier.

        Shortusual | official | temp | secondary | old (If known)
        Comments

        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

        Control0..1
        BindingThe codes SHALL be taken from IdentifierUse
        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

        Identifies the purpose for this identifier, if known .

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. PASMetricData.payerId.type
        Definition

        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

        ShortDescription of identifier
        Comments

        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
        (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows users to make use of identifiers when the identifier system is not known.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. PASMetricData.payerId.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        ShortThe namespace for the identifier value
        Comments

        Identifier.system is always case sensitive.

        Control1..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. PASMetricData.payerId.value
        Definition

        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        ShortThe value that is unique
        Comments

        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

        Control1..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Example<br/><b>General</b>:123456
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. PASMetricData.payerId.period
        Definition

        Time period during which identifier is/was valid for use.

        ShortTime period when id is/was valid for use
        Control0..1
        TypePeriod
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. PASMetricData.payerId.assigner
        Definition

        Organization that issued/manages the identifier.

        ShortOrganization that issued id (may be just text)
        Comments

        The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

        Control0..1
        TypeReference(Organization)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. PASMetricData.exchange
        Definition

        Exchanges between providers, intermediares, and payers to support prior authorization.

        ShortPrior Authorization Exchanges
        Control1..*
        TypeBackboneElement
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. PASMetricData.exchange.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        62. PASMetricData.exchange.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on PASMetricData.exchange.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 64. PASMetricData.exchange.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          66. PASMetricData.exchange.type
          Definition

          A code indicating the type of exchange

          Shortinitial | subsequent | cancel | update | query | initialDocToPayer
          Control1..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          68. PASMetricData.exchange.with
          Definition

          The destination for the exchange

          Shortprovider | intermediary | payer
          Control0..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          70. PASMetricData.exchange.method
          Definition

          Exchange standard used for this specific exchange. Note: RESTful is the default for any Provider to Intermediary exchange, X12 is the defalt for any exchange between the intermediary and the payer for the X12 278, the exchange of the PAS bundle between the intermediary and the payer may be any of the methods included in the value set.

          Shortx12 | restful | ihe | direct | other
          Control1..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          72. PASMetricData.exchange.requestTime
          Definition

          For providers, the request was made. For payers, the time the request was received. For intermediaries time the request was received from the provider or time the request was sent to the payer.

          ShortTime exchange initiated
          Control1..1
          Typeinstant
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          74. PASMetricData.exchange.responseTime
          Definition

          For providers, the response was received. For payers, the time the response was sent. For intermediaries time the response was sent to the provider or time the response was received from the payer.

          ShortTime of exchange response
          Control0..1
          Typeinstant
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          76. PASMetricData.exchange.httpResponse
          Definition

          What HTTP response code was returned for the exchange invocation.

          Shorte.g. 200
          Control1..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          78. PASMetricData.issue
          Definition

          In the event of an HTTP error, if an OperationOutcome was returned, what were the issues.

          ShortOperationOutcome info
          Control0..*
          TypeBackboneElement
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          80. PASMetricData.issue.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          82. PASMetricData.issue.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on PASMetricData.issue.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 84. PASMetricData.issue.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            86. PASMetricData.issue.code
            Definition

            The issue.code value from the OperationOutcome for this issue.

            ShortError code
            Control1..1
            BindingThe codes SHALL be taken from IssueType
            (required to http://hl7.org/fhir/ValueSet/issue-type)
            Typecode
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            88. PASMetricData.issue.details
            Definition

            The issue.details value from the OperationOutcome for this issue.

            ShortMore detailed error code
            Control0..1
            BindingFor example codes, see OperationOutcomeCodes
            (example to http://hl7.org/fhir/ValueSet/operation-outcome)
            TypeCodeableConcept
            90. PASMetricData.aaaCodes
            Definition

            Any AAA codes returned during the exchange.

            ShortAAA codes returned
            Control0..*
            TypeBackboneElement
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. PASMetricData.aaaCodes.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            94. PASMetricData.aaaCodes.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on PASMetricData.aaaCodes.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 96. PASMetricData.aaaCodes.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              98. PASMetricData.aaaCodes.loopID
              Definition

              X12 loop ID.

              Shortsee X12 loop IDs
              Control1..1
              Typecode
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              100. PASMetricData.aaaCodes.aaaCode
              Definition

              AAA code returned with response.

              Shortapproved | modified | denied
              Control1..1
              Typecode
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              102. PASMetricData.itemDetail
              Definition

              Service level detail. One interation of the backbone for each service item in the PA exchange.

              ShortService level item detail
              Control0..*
              TypeBackboneElement
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              104. PASMetricData.itemDetail.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              106. PASMetricData.itemDetail.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on PASMetricData.itemDetail.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 108. PASMetricData.itemDetail.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                110. PASMetricData.itemDetail.trn
                Definition

                Service level TRN assigned by the payer if a questionnaire is required.

                ShortService Level TRN
                Control0..1
                Typeinteger
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                112. PASMetricData.itemDetail.item
                Definition

                The specific procedure, item, medication, appointment, nutrition that is the subject of the order.

                Shorteg. ICD10, HCPCS, NDC
                Control1..1
                TypeCodeableConcept
                114. PASMetricData.itemDetail.assertionId
                Definition

                The unique ID for the order item returned by CRD in the coverage information.

                ShortUnique ID for order item
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                116. PASMetricData.itemDetail.initialSubmissionTime
                Definition

                Date/time of the initial submission of the servcie item. This may be the time of the initial PA request or the time of an updated that added the service item.

                ShortDate/time of the initial submission of the item
                Control0..1
                TypedateTime
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                118. PASMetricData.itemDetail.finalResponseTime
                Definition

                Date/time that the final result was returned for the specific service item.

                ShortDate/time of final result
                Control0..1
                TypedateTime
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                120. PASMetricData.itemDetail.responsesRequired
                Definition

                Number of responses (initial and any with result pended) for the service item.

                ShortNumber of responses
                Control0..1
                Typeinteger
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                122. PASMetricData.itemDetail.aaaCodes
                Definition

                Any AAA codes returned during the exchange.

                ShortAAA codes returned
                Control0..*
                TypeBackboneElement
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                124. PASMetricData.itemDetail.aaaCodes.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                126. PASMetricData.itemDetail.aaaCodes.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on PASMetricData.itemDetail.aaaCodes.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 128. PASMetricData.itemDetail.aaaCodes.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  130. PASMetricData.itemDetail.aaaCodes.loopID
                  Definition

                  X12 loop ID.

                  Shortsee X12 loop IDs
                  Control1..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  132. PASMetricData.itemDetail.aaaCodes.aaaCode
                  Definition

                  AAA error code returned in the response.

                  Shortapproved | modified | deined
                  Control1..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  134. PASMetricData.itemDetail.locationType
                  Definition

                  The site where the service will be performed.

                  Shortinpatient | outpatient | home
                  Control0..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  136. PASMetricData.itemDetail.result
                  Definition

                  Final result of the specific service item.

                  Shortapproved | modified | denied | pended
                  Control0..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  138. PASMetricData.itemDetail.denialReason
                  Definition

                  A code specifying the reason why the item was denied.

                  ShortDenial Reason
                  Control0..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  140. PASMetricData.supportingDoc
                  Definition

                  The URL of the questionnaire that was the basis for the questionnaireResponse submitted as part of the PAS bundle for the specific service item.

                  ShortDocumentation submitted as part of PAS Bundle
                  Control0..1
                  Typeurl
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  142. PASMetricData.requestedDoc
                  Definition

                  Documentation requested via 278 response.

                  ShortDocumentation requested via 278 response
                  Control0..*
                  TypeBackboneElement
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  144. PASMetricData.requestedDoc.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  146. PASMetricData.requestedDoc.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on PASMetricData.requestedDoc.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 148. PASMetricData.requestedDoc.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    150. PASMetricData.requestedDoc.docRequest
                    Definition

                    Coded requests for documentation in the 278 response. May be LOINC codes as determined by HIPAA tab or X12 codes from the PWK01 element.

                    ShortCoded requests for additional documentation
                    Control1..*
                    TypeCodeableConcept
                    152. PASMetricData.requestedDoc.timeRequested
                    Definition

                    Date/Time of initial request for this item (may be part of the initial submission or part an update.

                    ShortDate/Time of initial request
                    Control1..1
                    TypedateTime
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    154. PASMetricData.requestedDoc.timeSubmitted
                    Definition

                    Date/Time of final result for this item (may be part of the initial submission or part an update.

                    ShortDate/Time of final result
                    Control0..1
                    TypedateTime
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    156. PASMetricData.requestedDoc.submissionMethod
                    Definition

                    The technical method used to submit the requested additional documentation.

                    ShortCDex | portal | fax | x12 | other
                    Control0..1
                    Typecode
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    158. PASMetricData.exceptionSubmission
                    Definition

                    Indicator that exchange was performed under an exception grant from the National Standard Group.

                    ShortTrue if exchange is based on the exception grant
                    Control0..1
                    Typeboolean
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    160. PASMetricData.businessLine
                    Definition

                    A code that indicates which type of insurance the patient is covered by.

                    ShortE.g. MedicareAdvantage
                    Control0..1
                    TypeCodeableConcept