Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1 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 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

Logical Model: PAS Metric Data

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/PASMetricData Version: 2.1.0
Standards status: Informative Maturity Level: 1 Computable Name: PASMetricData
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.1

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

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

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

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... 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

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
PASMetricData.sourcerequiredMetricDataSource
http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource
from this IG
PASMetricData.issue.coderequiredIssueType
http://hl7.org/fhir/ValueSet/issue-type
from the FHIR Standard
PASMetricData.issue.detailsexampleOperationOutcomeCodes
http://hl7.org/fhir/ValueSet/operation-outcome
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
PASMetricData.sourcerequiredMetricDataSource
http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource
from this IG
PASMetricData.providerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.groupId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.payerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.issue.coderequiredIssueType
http://hl7.org/fhir/ValueSet/issue-type
from the FHIR Standard
PASMetricData.issue.detailsexampleOperationOutcomeCodes
http://hl7.org/fhir/ValueSet/operation-outcome
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. 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)
.... @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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
PASMetricData.sourcerequiredMetricDataSource
http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource
from this IG
PASMetricData.providerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.providerId.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
PASMetricData.groupId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.groupId.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
PASMetricData.payerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.payerId.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
PASMetricData.issue.coderequiredIssueType
http://hl7.org/fhir/ValueSet/issue-type
from the FHIR Standard
PASMetricData.issue.detailsexampleOperationOutcomeCodes
http://hl7.org/fhir/ValueSet/operation-outcome
from the FHIR Standard

This structure is derived from Base

Summary

Mandatory: 4 elements(17 nested mandatory elements)

Maturity: 1

Differential View

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... 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

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
PASMetricData.sourcerequiredMetricDataSource
http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource
from this IG
PASMetricData.issue.coderequiredIssueType
http://hl7.org/fhir/ValueSet/issue-type
from the FHIR Standard
PASMetricData.issue.detailsexampleOperationOutcomeCodes
http://hl7.org/fhir/ValueSet/operation-outcome
from the FHIR Standard

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
PASMetricData.sourcerequiredMetricDataSource
http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource
from this IG
PASMetricData.providerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.groupId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.payerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.issue.coderequiredIssueType
http://hl7.org/fhir/ValueSet/issue-type
from the FHIR Standard
PASMetricData.issue.detailsexampleOperationOutcomeCodes
http://hl7.org/fhir/ValueSet/operation-outcome
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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)
.... @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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
PASMetricData.sourcerequiredMetricDataSource
http://hl7.org/fhir/us/davinci-pas/ValueSet/MetricDataSource
from this IG
PASMetricData.providerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.providerId.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
PASMetricData.groupId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.groupId.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
PASMetricData.payerId.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
PASMetricData.payerId.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
PASMetricData.issue.coderequiredIssueType
http://hl7.org/fhir/ValueSet/issue-type
from the FHIR Standard
PASMetricData.issue.detailsexampleOperationOutcomeCodes
http://hl7.org/fhir/ValueSet/operation-outcome
from the FHIR Standard

This structure is derived from Base

Summary

Mandatory: 4 elements(17 nested mandatory elements)

Maturity: 1

 

Other representations of profile: CSV, Excel