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

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

Resource Profile: PAS Insurer Organization

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer Version: 2.0.1
Standards status: Trial-use Maturity Level: 3 Computable Name: PASInsurer

An organization who provides insurance and is the receiver of a prior authorization request.

Usage:

Formal Views of Profile Content

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

This structure is derived from PASOrganization

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization PASOrganization
... type S0..*CodeableConceptKind of organization
Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Organization.typerequiredhttps://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization C0..*PASOrganizationA grouping of people or organizations with a common purpose
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣC0..*PASIdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:NPI S0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... identifier:CLIA 0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
.... identifier:TIN SΣC0..1IdentifierThe US Employer Identification Number (EIN) or Tax Identification Number (TIN).

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
... type SΣ0..*CodeableConceptKind of organization
Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


... name SΣC1..1stringName used for the organization
... telecom SC0..*ContactPointA contact detail for the organization
... address SC0..*AddressAn address for the organization
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Organization.identifier:TIN.userequiredIdentifierUse
Organization.typerequiredhttps://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.userequiredAddressUse
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization C0..*PASOrganizationA grouping of people or organizations with a common purpose
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣC0..*PASIdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:NPI S0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:CLIA 0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:TIN SΣC0..1IdentifierThe US Employer Identification Number (EIN) or Tax Identification Number (TIN).

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription 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 Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!SΣ1..1booleanWhether the organization's record is still in active use
... type SΣ0..*CodeableConceptKind of organization
Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


... name SΣC1..1stringName used for the organization
... alias 0..*stringA list of alternate names that the organization is known as, or was known as in the past
... telecom SC0..*ContactPointA contact detail for the organization
... address SC0..*AddressAn address for the organization
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district Σ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23","end":"2010-07-01"}
... partOf Σ0..1Reference(Organization)The organization of which this organization forms a part
... contact 0..*BackboneElementContact for the organization for a certain purpose
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Organization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Organization.identifier:TIN.userequiredIdentifierUse
Organization.identifier:TIN.typeextensibleIdentifier Type Codes
Organization.typerequiredhttps://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.userequiredAddressUse
Organization.address.typerequiredAddressType
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes
Organization.contact.purposeextensibleContactEntityType

This structure is derived from PASOrganization

Summary

Must-Support: 1 element

Maturity: 3

Differential View

This structure is derived from PASOrganization

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization PASOrganization
... type S0..*CodeableConceptKind of organization
Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Organization.typerequiredhttps://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization C0..*PASOrganizationA grouping of people or organizations with a common purpose
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣC0..*PASIdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:NPI S0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
.... identifier:CLIA 0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
.... identifier:TIN SΣC0..1IdentifierThe US Employer Identification Number (EIN) or Tax Identification Number (TIN).

Required Pattern: At least the following
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
... type SΣ0..*CodeableConceptKind of organization
Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


... name SΣC1..1stringName used for the organization
... telecom SC0..*ContactPointA contact detail for the organization
... address SC0..*AddressAn address for the organization
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Organization.identifier:TIN.userequiredIdentifierUse
Organization.typerequiredhttps://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.userequiredAddressUse
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Organization C0..*PASOrganizationA grouping of people or organizations with a common purpose
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣC0..*PASIdentifierIdentifies this organization across multiple systems
Slice: Unordered, Open by pattern:$this
.... identifier:NPI S0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://hl7.org/fhir/sid/us-npi
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:CLIA 0..1PASIdentifierAn identifier intended for computation

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
.... identifier:TIN SΣC0..1IdentifierThe US Employer Identification Number (EIN) or Tax Identification Number (TIN).

Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... use0..1codeusual | official | temp | secondary | old (If known)
..... type0..1CodeableConceptDescription of identifier
..... system1..1uriThe namespace for the identifier value
Fixed Value: http://terminology.hl7.org/NamingSystem/USEIN
..... value0..1stringThe value that is unique
..... period0..1PeriodTime period when id is/was valid for use
..... assigner0..1Reference(Organization)Organization that issued id (may be just text)
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription 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 Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ0..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!SΣ1..1booleanWhether the organization's record is still in active use
... type SΣ0..*CodeableConceptKind of organization
Binding: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98 (required): Codes identifying an organizational entity, a physical location, property or an individual. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. All X12 work products are copyrighted. See their website for licensing terms and conditions.


... name SΣC1..1stringName used for the organization
... alias 0..*stringA list of alternate names that the organization is known as, or was known as in the past
... telecom SC0..*ContactPointA contact detail for the organization
... address SC0..*AddressAn address for the organization
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... use ?!Σ0..1codehome | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
.... type Σ0..1codepostal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
.... text Σ0..1stringText representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
.... line SΣ0..4stringStreet name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
.... city SΣ0..1stringName of city, town etc.
Example General: Erewhon
.... district Σ0..1stringDistrict name (aka county)
Example General: Madison
.... state SΣ0..1stringSub-unit of country (abbreviations ok)
Binding: USPS Two Letter Alphabetic Codes (extensible): Two letter USPS alphabetic codes.

.... postalCode SΣ0..1stringUS Zip Codes
Example General: 9132
.... country SΣ0..1stringCountry (e.g. can be ISO 3166 2 or 3 letter code)
.... period Σ0..1PeriodTime period when address was/is in use
Example General: {"start":"2010-03-23","end":"2010-07-01"}
... partOf Σ0..1Reference(Organization)The organization of which this organization forms a part
... contact 0..*BackboneElementContact for the organization for a certain purpose
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... purpose 0..1CodeableConceptThe type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name 0..1HumanNameA name associated with the contact
.... telecom 0..*ContactPointContact details (telephone, email, etc.) for a contact
.... address 0..1AddressVisiting or postal addresses for the contact
... endpoint 0..*Reference(Endpoint)Technical endpoints providing access to services operated for the organization

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
Organization.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
Organization.identifier:TIN.userequiredIdentifierUse
Organization.identifier:TIN.typeextensibleIdentifier Type Codes
Organization.typerequiredhttps://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
Organization.address.userequiredAddressUse
Organization.address.typerequiredAddressType
Organization.address.stateextensibleUspsTwoLetterAlphabeticCodes
Organization.contact.purposeextensibleContactEntityType

This structure is derived from PASOrganization

Summary

Must-Support: 1 element

Maturity: 3

 

Other representations of profile: CSV, Excel, Schematron