Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2
Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2
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
| Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/PASMetricData | Version: 2.0.1 | |||
| Standards status: Informative | Maturity Level: 1 | Computable Name: PASMetricData | ||
A logical model describing the information that should be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Base
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  PASMetricData | 0..* | Base | PAS Metric Data Instances of this logical model are not marked to be the target of a Reference | |
  source | 1..1 | code | provider | intermediary | payer Binding: Metric Data Source (required) | |
  providerId | 1..1 | Identifier | User invoking hook | |
 system | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi | |
 value | 1..1 | string | The value that is unique | |
| groupId | 1..1 | Identifier | Healthcare org of user | |
| system | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi | |
| value | 1..1 | string | The value that is unique | |
| payerId | 1..1 | Identifier | Payer receiving hook | |
| system | 1..1 | uri | The namespace for the identifier value | |
| value | 1..1 | string | The value that is unique | |
| exchange | 1..* | BackboneElement | Prior Authorization Exchanges | |
| type | 1..1 | code | initial | subsequent | cancel | update | query | initialDocToPayer | |
| with | 0..1 | code | provider | intermediary | payer | |
| method | 1..1 | code | x12 | restful | ihe | direct | other | |
| requestTime | 1..1 | instant | Time exchange initiated | |
| responseTime | 0..1 | instant | Time of exchange response | |
| httpResponse | 1..1 | code | e.g. 200 | |
| issue | 0..* | BackboneElement | OperationOutcome info | |
| code | 1..1 | code | Error code Binding: IssueType (required) | |
| details | 0..1 | CodeableConcept | More detailed error code Binding: OperationOutcomeCodes (example) | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | denied | |
| itemDetail | 0..* | BackboneElement | Service level item detail | |
| trn | 0..1 | integer | Service Level TRN | |
| item | 1..1 | CodeableConcept | eg. ICD10, HCPCS, NDC | |
| assertionId | 0..1 | string | Unique ID for order item | |
| initialSubmissionTime | 0..1 | dateTime | Date/time of the initial submission of the item | |
| finalResponseTime | 0..1 | dateTime | Date/time of final result | |
| responsesRequired | 0..1 | integer | Number of responses | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | deined | |
| locationType | 0..1 | code | inpatient | outpatient | home | |
| result | 0..1 | code | approved | modified | denied | pended | |
| denialReason | 0..1 | code | Denial Reason | |
| supportingDoc | 0..1 | url | Documentation submitted as part of PAS Bundle | |
| requestedDoc | 0..* | BackboneElement | Documentation requested via 278 response | |
| docRequest | 1..* | CodeableConcept | Coded requests for additional documentation | |
| timeRequested | 1..1 | dateTime | Date/Time of initial request | |
| timeSubmitted | 0..1 | dateTime | Date/Time of final result | |
| submissionMethod | 0..1 | code | CDex | portal | fax | x12 | other | |
| exceptionSubmission | 0..1 | boolean | True if exchange is based on the exception grant | |
| businessLine | 0..1 | CodeableConcept | E.g. MedicareAdvantage | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| PASMetricData.source | required | MetricDataSource |
| PASMetricData.issue.code | required | IssueType |
| PASMetricData.issue.details | example | OperationOutcomeCodes |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PASMetricData | 0..* | Base | PAS Metric Data Instances of this logical model are not marked to be the target of a Reference | |
| source | 1..1 | code | provider | intermediary | payer Binding: Metric Data Source (required) | |
| providerId | 1..1 | Identifier | User invoking hook | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| groupId | 1..1 | Identifier | Healthcare org of user | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| payerId | 1..1 | Identifier | Payer receiving hook | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| exchange | 1..* | BackboneElement | Prior Authorization Exchanges | |
 modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | code | initial | subsequent | cancel | update | query | initialDocToPayer | |
| with | 0..1 | code | provider | intermediary | payer | |
| method | 1..1 | code | x12 | restful | ihe | direct | other | |
| requestTime | 1..1 | instant | Time exchange initiated | |
| responseTime | 0..1 | instant | Time of exchange response | |
| httpResponse | 1..1 | code | e.g. 200 | |
| issue | 0..* | BackboneElement | OperationOutcome info | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | 1..1 | code | Error code Binding: IssueType (required) | |
| details | 0..1 | CodeableConcept | More detailed error code Binding: OperationOutcomeCodes (example) | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | denied | |
| itemDetail | 0..* | BackboneElement | Service level item detail | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| trn | 0..1 | integer | Service Level TRN | |
| item | 1..1 | CodeableConcept | eg. ICD10, HCPCS, NDC | |
| assertionId | 0..1 | string | Unique ID for order item | |
| initialSubmissionTime | 0..1 | dateTime | Date/time of the initial submission of the item | |
| finalResponseTime | 0..1 | dateTime | Date/time of final result | |
| responsesRequired | 0..1 | integer | Number of responses | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | deined | |
| locationType | 0..1 | code | inpatient | outpatient | home | |
| result | 0..1 | code | approved | modified | denied | pended | |
| denialReason | 0..1 | code | Denial Reason | |
| supportingDoc | 0..1 | url | Documentation submitted as part of PAS Bundle | |
| requestedDoc | 0..* | BackboneElement | Documentation requested via 278 response | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| docRequest | 1..* | CodeableConcept | Coded requests for additional documentation | |
| timeRequested | 1..1 | dateTime | Date/Time of initial request | |
| timeSubmitted | 0..1 | dateTime | Date/Time of final result | |
| submissionMethod | 0..1 | code | CDex | portal | fax | x12 | other | |
| exceptionSubmission | 0..1 | boolean | True if exchange is based on the exception grant | |
| businessLine | 0..1 | CodeableConcept | E.g. MedicareAdvantage | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| PASMetricData.source | required | MetricDataSource |
| PASMetricData.providerId.use | required | IdentifierUse |
| PASMetricData.groupId.use | required | IdentifierUse |
| PASMetricData.payerId.use | required | IdentifierUse |
| PASMetricData.issue.code | required | IssueType |
| PASMetricData.issue.details | example | OperationOutcomeCodes |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PASMetricData | 0..* | Base | PAS Metric Data Instances of this logical model are not marked to be the target of a Reference | |
| source | 1..1 | code | provider | intermediary | payer Binding: Metric Data Source (required) | |
| providerId | 1..1 | Identifier | User invoking hook | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
 extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| period | Σ | 0..1 | Period | Time period when id is/was valid for use |
 assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| groupId | 1..1 | Identifier | Healthcare org of user | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| period | Σ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| payerId | 1..1 | Identifier | Payer receiving hook | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| period | Σ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| exchange | 1..* | BackboneElement | Prior Authorization Exchanges | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | code | initial | subsequent | cancel | update | query | initialDocToPayer | |
| with | 0..1 | code | provider | intermediary | payer | |
| method | 1..1 | code | x12 | restful | ihe | direct | other | |
| requestTime | 1..1 | instant | Time exchange initiated | |
| responseTime | 0..1 | instant | Time of exchange response | |
| httpResponse | 1..1 | code | e.g. 200 | |
| issue | 0..* | BackboneElement | OperationOutcome info | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | 1..1 | code | Error code Binding: IssueType (required) | |
| details | 0..1 | CodeableConcept | More detailed error code Binding: OperationOutcomeCodes (example) | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | denied | |
| itemDetail | 0..* | BackboneElement | Service level item detail | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| trn | 0..1 | integer | Service Level TRN | |
| item | 1..1 | CodeableConcept | eg. ICD10, HCPCS, NDC | |
| assertionId | 0..1 | string | Unique ID for order item | |
| initialSubmissionTime | 0..1 | dateTime | Date/time of the initial submission of the item | |
| finalResponseTime | 0..1 | dateTime | Date/time of final result | |
| responsesRequired | 0..1 | integer | Number of responses | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | deined | |
| locationType | 0..1 | code | inpatient | outpatient | home | |
| result | 0..1 | code | approved | modified | denied | pended | |
| denialReason | 0..1 | code | Denial Reason | |
| supportingDoc | 0..1 | url | Documentation submitted as part of PAS Bundle | |
| requestedDoc | 0..* | BackboneElement | Documentation requested via 278 response | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| docRequest | 1..* | CodeableConcept | Coded requests for additional documentation | |
| timeRequested | 1..1 | dateTime | Date/Time of initial request | |
| timeSubmitted | 0..1 | dateTime | Date/Time of final result | |
| submissionMethod | 0..1 | code | CDex | portal | fax | x12 | other | |
| exceptionSubmission | 0..1 | boolean | True if exchange is based on the exception grant | |
| businessLine | 0..1 | CodeableConcept | E.g. MedicareAdvantage | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| PASMetricData.source | required | MetricDataSource |
| PASMetricData.providerId.use | required | IdentifierUse |
| PASMetricData.providerId.type | extensible | Identifier Type Codes |
| PASMetricData.groupId.use | required | IdentifierUse |
| PASMetricData.groupId.type | extensible | Identifier Type Codes |
| PASMetricData.payerId.use | required | IdentifierUse |
| PASMetricData.payerId.type | extensible | Identifier Type Codes |
| PASMetricData.issue.code | required | IssueType |
| PASMetricData.issue.details | example | OperationOutcomeCodes |
Differential View
This structure is derived from Base
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PASMetricData | 0..* | Base | PAS Metric Data Instances of this logical model are not marked to be the target of a Reference | |
| source | 1..1 | code | provider | intermediary | payer Binding: Metric Data Source (required) | |
| providerId | 1..1 | Identifier | User invoking hook | |
| system | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi | |
| value | 1..1 | string | The value that is unique | |
| groupId | 1..1 | Identifier | Healthcare org of user | |
| system | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi | |
| value | 1..1 | string | The value that is unique | |
| payerId | 1..1 | Identifier | Payer receiving hook | |
| system | 1..1 | uri | The namespace for the identifier value | |
| value | 1..1 | string | The value that is unique | |
| exchange | 1..* | BackboneElement | Prior Authorization Exchanges | |
| type | 1..1 | code | initial | subsequent | cancel | update | query | initialDocToPayer | |
| with | 0..1 | code | provider | intermediary | payer | |
| method | 1..1 | code | x12 | restful | ihe | direct | other | |
| requestTime | 1..1 | instant | Time exchange initiated | |
| responseTime | 0..1 | instant | Time of exchange response | |
| httpResponse | 1..1 | code | e.g. 200 | |
| issue | 0..* | BackboneElement | OperationOutcome info | |
| code | 1..1 | code | Error code Binding: IssueType (required) | |
| details | 0..1 | CodeableConcept | More detailed error code Binding: OperationOutcomeCodes (example) | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | denied | |
| itemDetail | 0..* | BackboneElement | Service level item detail | |
| trn | 0..1 | integer | Service Level TRN | |
| item | 1..1 | CodeableConcept | eg. ICD10, HCPCS, NDC | |
| assertionId | 0..1 | string | Unique ID for order item | |
| initialSubmissionTime | 0..1 | dateTime | Date/time of the initial submission of the item | |
| finalResponseTime | 0..1 | dateTime | Date/time of final result | |
| responsesRequired | 0..1 | integer | Number of responses | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | deined | |
| locationType | 0..1 | code | inpatient | outpatient | home | |
| result | 0..1 | code | approved | modified | denied | pended | |
| denialReason | 0..1 | code | Denial Reason | |
| supportingDoc | 0..1 | url | Documentation submitted as part of PAS Bundle | |
| requestedDoc | 0..* | BackboneElement | Documentation requested via 278 response | |
| docRequest | 1..* | CodeableConcept | Coded requests for additional documentation | |
| timeRequested | 1..1 | dateTime | Date/Time of initial request | |
| timeSubmitted | 0..1 | dateTime | Date/Time of final result | |
| submissionMethod | 0..1 | code | CDex | portal | fax | x12 | other | |
| exceptionSubmission | 0..1 | boolean | True if exchange is based on the exception grant | |
| businessLine | 0..1 | CodeableConcept | E.g. MedicareAdvantage | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| PASMetricData.source | required | MetricDataSource |
| PASMetricData.issue.code | required | IssueType |
| PASMetricData.issue.details | example | OperationOutcomeCodes |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PASMetricData | 0..* | Base | PAS Metric Data Instances of this logical model are not marked to be the target of a Reference | |
| source | 1..1 | code | provider | intermediary | payer Binding: Metric Data Source (required) | |
| providerId | 1..1 | Identifier | User invoking hook | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| groupId | 1..1 | Identifier | Healthcare org of user | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| payerId | 1..1 | Identifier | Payer receiving hook | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| exchange | 1..* | BackboneElement | Prior Authorization Exchanges | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | code | initial | subsequent | cancel | update | query | initialDocToPayer | |
| with | 0..1 | code | provider | intermediary | payer | |
| method | 1..1 | code | x12 | restful | ihe | direct | other | |
| requestTime | 1..1 | instant | Time exchange initiated | |
| responseTime | 0..1 | instant | Time of exchange response | |
| httpResponse | 1..1 | code | e.g. 200 | |
| issue | 0..* | BackboneElement | OperationOutcome info | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | 1..1 | code | Error code Binding: IssueType (required) | |
| details | 0..1 | CodeableConcept | More detailed error code Binding: OperationOutcomeCodes (example) | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | denied | |
| itemDetail | 0..* | BackboneElement | Service level item detail | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| trn | 0..1 | integer | Service Level TRN | |
| item | 1..1 | CodeableConcept | eg. ICD10, HCPCS, NDC | |
| assertionId | 0..1 | string | Unique ID for order item | |
| initialSubmissionTime | 0..1 | dateTime | Date/time of the initial submission of the item | |
| finalResponseTime | 0..1 | dateTime | Date/time of final result | |
| responsesRequired | 0..1 | integer | Number of responses | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | deined | |
| locationType | 0..1 | code | inpatient | outpatient | home | |
| result | 0..1 | code | approved | modified | denied | pended | |
| denialReason | 0..1 | code | Denial Reason | |
| supportingDoc | 0..1 | url | Documentation submitted as part of PAS Bundle | |
| requestedDoc | 0..* | BackboneElement | Documentation requested via 278 response | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| docRequest | 1..* | CodeableConcept | Coded requests for additional documentation | |
| timeRequested | 1..1 | dateTime | Date/Time of initial request | |
| timeSubmitted | 0..1 | dateTime | Date/Time of final result | |
| submissionMethod | 0..1 | code | CDex | portal | fax | x12 | other | |
| exceptionSubmission | 0..1 | boolean | True if exchange is based on the exception grant | |
| businessLine | 0..1 | CodeableConcept | E.g. MedicareAdvantage | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| PASMetricData.source | required | MetricDataSource |
| PASMetricData.providerId.use | required | IdentifierUse |
| PASMetricData.groupId.use | required | IdentifierUse |
| PASMetricData.payerId.use | required | IdentifierUse |
| PASMetricData.issue.code | required | IssueType |
| PASMetricData.issue.details | example | OperationOutcomeCodes |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| PASMetricData | 0..* | Base | PAS Metric Data Instances of this logical model are not marked to be the target of a Reference | |
| source | 1..1 | code | provider | intermediary | payer Binding: Metric Data Source (required) | |
| providerId | 1..1 | Identifier | User invoking hook | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| period | Σ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| groupId | 1..1 | Identifier | Healthcare org of user | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | Σ | 0..1 | uri | The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| period | Σ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| payerId | 1..1 | Identifier | Payer receiving hook | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| use | ?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type | Σ | 0..1 | CodeableConcept | Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. |
| system | Σ | 1..1 | uri | The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient |
| value | Σ | 1..1 | string | The value that is unique Example General: 123456 |
| period | Σ | 0..1 | Period | Time period when id is/was valid for use |
| assigner | Σ | 0..1 | Reference(Organization) | Organization that issued id (may be just text) |
| exchange | 1..* | BackboneElement | Prior Authorization Exchanges | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | code | initial | subsequent | cancel | update | query | initialDocToPayer | |
| with | 0..1 | code | provider | intermediary | payer | |
| method | 1..1 | code | x12 | restful | ihe | direct | other | |
| requestTime | 1..1 | instant | Time exchange initiated | |
| responseTime | 0..1 | instant | Time of exchange response | |
| httpResponse | 1..1 | code | e.g. 200 | |
| issue | 0..* | BackboneElement | OperationOutcome info | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | 1..1 | code | Error code Binding: IssueType (required) | |
| details | 0..1 | CodeableConcept | More detailed error code Binding: OperationOutcomeCodes (example) | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | denied | |
| itemDetail | 0..* | BackboneElement | Service level item detail | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| trn | 0..1 | integer | Service Level TRN | |
| item | 1..1 | CodeableConcept | eg. ICD10, HCPCS, NDC | |
| assertionId | 0..1 | string | Unique ID for order item | |
| initialSubmissionTime | 0..1 | dateTime | Date/time of the initial submission of the item | |
| finalResponseTime | 0..1 | dateTime | Date/time of final result | |
| responsesRequired | 0..1 | integer | Number of responses | |
| aaaCodes | 0..* | BackboneElement | AAA codes returned | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| loopID | 1..1 | code | see X12 loop IDs | |
| aaaCode | 1..1 | code | approved | modified | deined | |
| locationType | 0..1 | code | inpatient | outpatient | home | |
| result | 0..1 | code | approved | modified | denied | pended | |
| denialReason | 0..1 | code | Denial Reason | |
| supportingDoc | 0..1 | url | Documentation submitted as part of PAS Bundle | |
| requestedDoc | 0..* | BackboneElement | Documentation requested via 278 response | |
| @id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| docRequest | 1..* | CodeableConcept | Coded requests for additional documentation | |
| timeRequested | 1..1 | dateTime | Date/Time of initial request | |
| timeSubmitted | 0..1 | dateTime | Date/Time of final result | |
| submissionMethod | 0..1 | code | CDex | portal | fax | x12 | other | |
| exceptionSubmission | 0..1 | boolean | True if exchange is based on the exception grant | |
| businessLine | 0..1 | CodeableConcept | E.g. MedicareAdvantage | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| PASMetricData.source | required | MetricDataSource |
| PASMetricData.providerId.use | required | IdentifierUse |
| PASMetricData.providerId.type | extensible | Identifier Type Codes |
| PASMetricData.groupId.use | required | IdentifierUse |
| PASMetricData.groupId.type | extensible | Identifier Type Codes |
| PASMetricData.payerId.use | required | IdentifierUse |
| PASMetricData.payerId.type | extensible | Identifier Type Codes |
| PASMetricData.issue.code | required | IssueType |
| PASMetricData.issue.details | example | OperationOutcomeCodes |
IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pas#2.0.1 based on FHIR 4.0.1. Generated 2024-01-08
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