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

Resource Profile: PASClaimUpdate - Mappings

Page standards status: Trial-use Maturity Level: 3

Mappings for the profile-claim-update resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

PASClaimUpdate
ClaimRequest
   statusRequest.status
   patientRequest.subject
   createdRequest.authoredOn
   insurerRequest.performer
   providerRequest.requester
   priorityRequest.priority
   related
      claimRequest.replaces
   supportingInfoRequest.supportingInfo
   supportingInfo (PatientEvent)Request.supportingInfo
   supportingInfo (AdmissionDates)Request.supportingInfo
   supportingInfo (DischargeDates)Request.supportingInfo
   supportingInfo (AdditionalInformation)Request.supportingInfo
   supportingInfo (MessageText)Request.supportingInfo
   diagnosisRequest.reasonReference
   insurance
      identifierRequest.identifier
   item
      encounterRequest.context

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

PASClaimUpdate
Claim
   statusFiveWs.status
   typeFiveWs.class
   subTypeFiveWs.class
   useFiveWs.class
   patientFiveWs.subject[x], FiveWs.subject
   billablePeriodFiveWs.done[x]
   createdFiveWs.recorded
   entererFiveWs.author
   providerFiveWs.source
   referralFiveWs.cause
   facilityFiveWs.where[x]
   careTeam
      providerFiveWs.actor
   careTeam (OverallClaimMember)
      providerFiveWs.actor
   careTeam (ItemClaimMember)
      providerFiveWs.actor
   insurance
      identifierFiveWs.identifier
   item
      serviced[x]FiveWs.done[x]
      serviced[x] (servicedDate)FiveWs.done[x]
      serviced[x] (servicedPeriod)FiveWs.done[x]
      location[x]FiveWs.where[x]

Mappings for RIM Mapping (http://hl7.org/v3)

PASClaimUpdate
ClaimEntity. Role, or Act
   textAct.text?
   containedN/A
   extension
   extension (levelOfServiceType)
   extension (conditionCode)
   extension (homeHealthCareInformation)
   extension (encounter)n/a, N/A
      idn/a
      urlN/A
      value[x]N/A
   modifierExtensionN/A
   identifiern/a, II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
      idn/a
      extensionn/a
      useRole.code or implied by context
      typeRole.code or implied by context
      systemII.root or Role.id.root
      valueII.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
      periodRole.effectiveTime or implied by context
      assignerII.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
   related
      idn/a
      extensionn/a
      modifierExtensionN/A
   payee
      idn/a
      extensionn/a
      modifierExtensionN/A
   careTeam
      idn/a
      extension
      extension (careTeamClaimScope)
      modifierExtensionN/A
   careTeam (OverallClaimMember)
      idn/a
      extension
      extension (careTeamClaimScope)
         idn/a
         urlN/A
         value[x]N/A
      modifierExtensionN/A
   careTeam (ItemClaimMember)
      idn/a
      extension
      extension (careTeamClaimScope)
         idn/a
         urlN/A
         value[x]N/A
      modifierExtensionN/A
   supportingInfo
      idn/a
      timing[x]
   supportingInfo (PatientEvent)
      idn/a
      extensionn/a
      modifierExtensionN/A
      timing[x]
      timing[x] (timingDate)
      timing[x] (timingPeriod)
         idn/a
         extensionn/a
         start./low
         end./high
   supportingInfo (AdmissionDates)
      idn/a
      extensionn/a
      modifierExtensionN/A
      timing[x]
      timing[x] (timingDate)
      timing[x] (timingPeriod)
         idn/a
         extensionn/a
         start./low
         end./high
   supportingInfo (DischargeDates)
      idn/a
      extensionn/a
      modifierExtensionN/A
      timing[x]
      timing[x] (timingDate)
      timing[x] (timingPeriod)
         idn/a
         extensionn/a
         start./low
         end./high
   supportingInfo (AdditionalInformation)
      idn/a
      extensionn/a
      modifierExtensionN/A
   supportingInfo (MessageText)
      idn/a
      extensionn/a
      modifierExtensionN/A
   diagnosis
      idn/a
      modifierExtensionN/A
   procedure
      idn/a
      extensionn/a
      modifierExtensionN/A
   insuranceCoverage
      idn/a
      extensionn/a
      modifierExtensionN/A
   accident
      idn/a
      extensionn/a
      modifierExtensionN/A
   item
      idn/a
      extension
      extension (itemTraceNumber)
      extension (authorizationNumber)
      extension (administrationReferenceNumber)
      extension (requestType)
      extension (certificationType)
      extension (productOrServiceCodeEnd)
      extension (epsdtIndicator)
      extension (nursingHomeResidentialStatus)
         idn/a
         urlN/A
         value[x]N/A
      serviced[x]
      serviced[x] (servicedDate)
      serviced[x] (servicedPeriod)
         idn/a
         extensionn/a
         start./low
         end./high
      quantityn/a, PQ, IVL<PQ>, MO, CO, depending on the values
      detail
         idn/a
         extensionn/a
         modifierExtensionN/A
         subDetail
            idn/a
            extensionn/a
            modifierExtensionN/A