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/profile-devicerequest | Version: 2.0.1 | |||
| Standards status: Trial-use | Maturity Level: 3 | Computable Name: PASDeviceRequest | ||
PAS constraints on DeviceRequest resource mandating support for elements relevant to the devices being requested on a prior authorization request
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from DeviceRequest
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  DeviceRequest |
0..* | DeviceRequest | Medical device request | |
  Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
   coverage |
S | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information |
  intent |
1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Fixed Value: order | |
 code[x] |
S | 1..1 | CodeableConcept | Device requested Binding: X12 278 Requested Service Type (required) |
 subject |
S | 1..1 | Reference(PAS Beneficiary Patient) | Focus of request |
 occurrence[x] |
S | 0..1 | PASTiming | A timing schedule that specifies an event that may occur multiple times |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| DeviceRequest.code[x] | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DeviceRequest |
0..* | DeviceRequest | Medical device request | |
 implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| coverage |
SC | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc' crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist. crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'. crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'. crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!Σ | 0..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes representing the status of the request. |
| intent |
?!Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of diagnostic request. Fixed Value: order |
| code[x] |
SΣ | 1..1 | CodeableConcept | Device requested Binding: X12 278 Requested Service Type (required) |
| subject |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | Focus of request |
| occurrence[x] |
S | 0..1 | PASTiming | A timing schedule that specifies an event that may occur multiple times |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| DeviceRequest.status | required | RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1from the FHIR Standard | |
| DeviceRequest.intent | required | Fixed Value: orderhttp://hl7.org/fhir/ValueSet/request-intent|4.0.1from the FHIR Standard | |
| DeviceRequest.code[x] | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| DeviceRequest |
0..* | DeviceRequest | Medical device request | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| coverage |
SC | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc' crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist. crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'. crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'. crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
Σ | 0..* | Identifier | External Request identifier | ||||
| instantiatesCanonical |
Σ | 0..* | canonical(ActivityDefinition | PlanDefinition) | Instantiates FHIR protocol or definition | ||||
| instantiatesUri |
Σ | 0..* | uri | Instantiates external protocol or definition | ||||
| basedOn |
Σ | 0..* | Reference(Resource) | What request fulfills | ||||
| priorRequest |
Σ | 0..* | Reference(Resource) | What request replaces | ||||
| groupIdentifier |
Σ | 0..1 | Identifier | Identifier of composite request | ||||
| status |
?!Σ | 0..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes representing the status of the request. | ||||
| intent |
?!Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of diagnostic request. Fixed Value: order | ||||
| priority |
Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request. | ||||
| code[x] |
SΣ | 1..1 | CodeableConcept | Device requested Binding: X12 278 Requested Service Type (required) | ||||
| parameter |
0..* | BackboneElement | Device details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
0..1 | CodeableConcept | Device detail Binding: (unbound) (example): A code that identifies the device detail. | |||||
  value[x] |
0..1 | Value of detail | ||||||
 valueCodeableConcept |
CodeableConcept | |||||||
| valueQuantity |
Quantity | |||||||
| valueRange |
Range | |||||||
| valueBoolean |
boolean | |||||||
| subject |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | Focus of request | ||||
| encounter |
Σ | 0..1 | Reference(Encounter) | Encounter motivating request | ||||
| occurrence[x] |
S | 0..1 | PASTiming | A timing schedule that specifies an event that may occur multiple times | ||||
| authoredOn |
Σ | 0..1 | dateTime | When recorded | ||||
| requester |
Σ | 0..1 | Reference(Device | Practitioner | PractitionerRole | Organization) | Who/what is requesting diagnostics | ||||
| performerType |
Σ | 0..1 | CodeableConcept | Filler role Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc. | ||||
| performer |
Σ | 0..1 | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | Requested Filler | ||||
| reasonCode |
Σ | 0..* | CodeableConcept | Coded Reason for request Binding: Condition/Problem/DiagnosisCodes (example): Diagnosis or problem codes justifying the reason for requesting the device. | ||||
| reasonReference |
Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Linked Reason for request | ||||
| insurance |
0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage | |||||
| supportingInfo |
0..* | Reference(Resource) | Additional clinical information | |||||
| note |
0..* | Annotation | Notes or comments | |||||
| relevantHistory |
0..* | Reference(Provenance) | Request provenance | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| DeviceRequest.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| DeviceRequest.status | required | RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1from the FHIR Standard | ||||
| DeviceRequest.intent | required | Fixed Value: orderhttp://hl7.org/fhir/ValueSet/request-intent|4.0.1from the FHIR Standard | ||||
| DeviceRequest.priority | required | RequestPriorityhttp://hl7.org/fhir/ValueSet/request-priority|4.0.1from the FHIR Standard | ||||
| DeviceRequest.code[x] | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG | ||||
| DeviceRequest.parameter.code | example | |||||
| DeviceRequest.performerType | example | ParticipantRoleshttp://hl7.org/fhir/ValueSet/participant-rolefrom the FHIR Standard | ||||
| DeviceRequest.reasonCode | example | Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-codefrom the FHIR Standard |
This structure is derived from DeviceRequest
Summary
Must-Support: 4 elements
Fixed: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Maturity: 3
Differential View
This structure is derived from DeviceRequest
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DeviceRequest |
0..* | DeviceRequest | Medical device request | |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| coverage |
S | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information |
| intent |
1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Fixed Value: order | |
| code[x] |
S | 1..1 | CodeableConcept | Device requested Binding: X12 278 Requested Service Type (required) |
| subject |
S | 1..1 | Reference(PAS Beneficiary Patient) | Focus of request |
| occurrence[x] |
S | 0..1 | PASTiming | A timing schedule that specifies an event that may occur multiple times |
| Documentation for this format | ||||
| Path | Conformance | ValueSet | URI |
| DeviceRequest.code[x] | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| DeviceRequest |
0..* | DeviceRequest | Medical device request | |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| coverage |
SC | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc' crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist. crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'. crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'. crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!Σ | 0..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes representing the status of the request. |
| intent |
?!Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of diagnostic request. Fixed Value: order |
| code[x] |
SΣ | 1..1 | CodeableConcept | Device requested Binding: X12 278 Requested Service Type (required) |
| subject |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | Focus of request |
| occurrence[x] |
S | 0..1 | PASTiming | A timing schedule that specifies an event that may occur multiple times |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| DeviceRequest.status | required | RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1from the FHIR Standard | |
| DeviceRequest.intent | required | Fixed Value: orderhttp://hl7.org/fhir/ValueSet/request-intent|4.0.1from the FHIR Standard | |
| DeviceRequest.code[x] | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| DeviceRequest |
0..* | DeviceRequest | Medical device request | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
Σ | 0..1 | Meta | Metadata about the resource | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| coverage |
SC | 0..1 | (Complex) | CoverageInfo URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc' crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist. crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'. crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'. crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'. | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
Σ | 0..* | Identifier | External Request identifier | ||||
| instantiatesCanonical |
Σ | 0..* | canonical(ActivityDefinition | PlanDefinition) | Instantiates FHIR protocol or definition | ||||
| instantiatesUri |
Σ | 0..* | uri | Instantiates external protocol or definition | ||||
| basedOn |
Σ | 0..* | Reference(Resource) | What request fulfills | ||||
| priorRequest |
Σ | 0..* | Reference(Resource) | What request replaces | ||||
| groupIdentifier |
Σ | 0..1 | Identifier | Identifier of composite request | ||||
| status |
?!Σ | 0..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Codes representing the status of the request. | ||||
| intent |
?!Σ | 1..1 | code | proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option Binding: RequestIntent (required): The kind of diagnostic request. Fixed Value: order | ||||
| priority |
Σ | 0..1 | code | routine | urgent | asap | stat Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request. | ||||
| code[x] |
SΣ | 1..1 | CodeableConcept | Device requested Binding: X12 278 Requested Service Type (required) | ||||
| parameter |
0..* | BackboneElement | Device details | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
0..1 | CodeableConcept | Device detail Binding: (unbound) (example): A code that identifies the device detail. | |||||
| value[x] |
0..1 | Value of detail | ||||||
| valueCodeableConcept |
CodeableConcept | |||||||
| valueQuantity |
Quantity | |||||||
| valueRange |
Range | |||||||
| valueBoolean |
boolean | |||||||
| subject |
SΣ | 1..1 | Reference(PAS Beneficiary Patient) | Focus of request | ||||
| encounter |
Σ | 0..1 | Reference(Encounter) | Encounter motivating request | ||||
| occurrence[x] |
S | 0..1 | PASTiming | A timing schedule that specifies an event that may occur multiple times | ||||
| authoredOn |
Σ | 0..1 | dateTime | When recorded | ||||
| requester |
Σ | 0..1 | Reference(Device | Practitioner | PractitionerRole | Organization) | Who/what is requesting diagnostics | ||||
| performerType |
Σ | 0..1 | CodeableConcept | Filler role Binding: ParticipantRoles (example): Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc. | ||||
| performer |
Σ | 0..1 | Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) | Requested Filler | ||||
| reasonCode |
Σ | 0..* | CodeableConcept | Coded Reason for request Binding: Condition/Problem/DiagnosisCodes (example): Diagnosis or problem codes justifying the reason for requesting the device. | ||||
| reasonReference |
Σ | 0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Linked Reason for request | ||||
| insurance |
0..* | Reference(Coverage | ClaimResponse) | Associated insurance coverage | |||||
| supportingInfo |
0..* | Reference(Resource) | Additional clinical information | |||||
| note |
0..* | Annotation | Notes or comments | |||||
| relevantHistory |
0..* | Reference(Provenance) | Request provenance | |||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| DeviceRequest.language | preferred | CommonLanguages
http://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard | ||||
| DeviceRequest.status | required | RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1from the FHIR Standard | ||||
| DeviceRequest.intent | required | Fixed Value: orderhttp://hl7.org/fhir/ValueSet/request-intent|4.0.1from the FHIR Standard | ||||
| DeviceRequest.priority | required | RequestPriorityhttp://hl7.org/fhir/ValueSet/request-priority|4.0.1from the FHIR Standard | ||||
| DeviceRequest.code[x] | required | X12278RequestedServiceTypehttp://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceTypefrom this IG | ||||
| DeviceRequest.parameter.code | example | |||||
| DeviceRequest.performerType | example | ParticipantRoleshttp://hl7.org/fhir/ValueSet/participant-rolefrom the FHIR Standard | ||||
| DeviceRequest.reasonCode | example | Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-codefrom the FHIR Standard |
This structure is derived from DeviceRequest
Summary
Must-Support: 4 elements
Fixed: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Maturity: 3
Other representations of profile: CSV, Excel, Schematron
IG © 2020+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pas#2.0.1 based on FHIR 4.0.1. Generated 2024-05-28
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