Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - 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 2.1.0-preview 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 Service Request

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest Version: 2.1.0-preview
Standards status: Trial-use Maturity Level: 3 Computable Name: PASServiceRequest

PAS constraints on ServiceRequest resource mandating support for elements relevant to the generic services being requested on 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 ServiceRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..* ServiceRequest A request for a service to be performed
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... serviceCodeEnd S 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... coverage S 0..1 (Complex) CoverageInfo
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... intent S 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Fixed Value: order
... code S 0..1 CodeableConcept What is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... subject S 1..1 Reference(PAS Beneficiary Patient) Individual or Entity the service is ordered for
... occurrence[x] S 0..1 PASTiming A timing schedule that specifies an event that may occur multiple times

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
ServiceRequest.coderequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
prr-1: orderDetail SHALL only be present if code is present
... 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
.... serviceCodeEnd S 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... 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
... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 0..1 CodeableConcept What is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... quantity[x] SΣ 0..1 Quantity Service amount
... subject SΣ 1..1 Reference(PAS Beneficiary Patient) Individual or Entity the service is ordered for
... occurrence[x] S 0..1 PASTiming A timing schedule that specifies an event that may occur multiple times

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.coderequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG
NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
prr-1: orderDetail SHALL only be present if code is present
... 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.

Additional BindingsPurpose
AllLanguages Max Binding
... 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
.... serviceCodeEnd S 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... 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 Identifiers assigned to this order
... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(CarePlan | ServiceRequest | MedicationRequest) What request fulfills
... replaces Σ 0..* Reference(ServiceRequest) What request replaces
... requisition Σ 0..1 Identifier Composite Request ID
... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category Σ 0..* CodeableConcept Classification of service
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 0..1 CodeableConcept What is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... orderDetail ΣC 0..* CodeableConcept Additional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] SΣ 0..1 Quantity Service amount
... subject SΣ 1..1 Reference(PAS Beneficiary Patient) Individual or Entity the service is ordered for
... encounter Σ 0..1 Reference(Encounter) Encounter in which the request was created
... occurrence[x] S 0..1 PASTiming A timing schedule that specifies an event that may occur multiple times
... asNeeded[x] Σ 0..1 Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBoolean boolean
.... asNeededCodeableConcept CodeableConcept
... authoredOn Σ 0..1 dateTime Date request signed
... requester Σ 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Who/what is requesting service
... performerType Σ 0..1 CodeableConcept Performer 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..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Requested performer
... locationCode Σ 0..* CodeableConcept Requested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ 0..* Reference(Location) Requested location
... reasonCode Σ 0..* CodeableConcept Explanation/Justification for procedure or service
Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


... reasonReference Σ 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Explanation/Justification for service or service
... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
... supportingInfo 0..* Reference(Resource) Additional clinical information
... specimen Σ 0..* Reference(Specimen) Procedure Samples
... bodySite Σ 0..* CodeableConcept Location on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..* Annotation Comments
... patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
... relevantHistory 0..* Reference(Provenance) Request provenance

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
ServiceRequest.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.categoryexampleServiceRequestCategoryCodes
http://hl7.org/fhir/ValueSet/servicerequest-category
from the FHIR Standard
ServiceRequest.priorityrequiredRequestPriority
http://hl7.org/fhir/ValueSet/request-priority|4.0.1
from the FHIR Standard
ServiceRequest.coderequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG
ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
http://hl7.org/fhir/ValueSet/servicerequest-orderdetail
from the FHIR Standard
ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
ServiceRequest.performerTypeexampleParticipantRoles
http://hl7.org/fhir/ValueSet/participant-role
from the FHIR Standard
ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCodeexampleProcedureReasonCodes
http://hl7.org/fhir/ValueSet/procedure-reason
from the FHIR Standard
ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard

Differential View

This structure is derived from ServiceRequest

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest 0..* ServiceRequest A request for a service to be performed
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... serviceCodeEnd S 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... coverage S 0..1 (Complex) CoverageInfo
URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
... intent S 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Fixed Value: order
... code S 0..1 CodeableConcept What is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... subject S 1..1 Reference(PAS Beneficiary Patient) Individual or Entity the service is ordered for
... occurrence[x] S 0..1 PASTiming A timing schedule that specifies an event that may occur multiple times

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
ServiceRequest.coderequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
prr-1: orderDetail SHALL only be present if code is present
... 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
.... serviceCodeEnd S 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... 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
... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 0..1 CodeableConcept What is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... quantity[x] SΣ 0..1 Quantity Service amount
... subject SΣ 1..1 Reference(PAS Beneficiary Patient) Individual or Entity the service is ordered for
... occurrence[x] S 0..1 PASTiming A timing schedule that specifies an event that may occur multiple times

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.coderequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ServiceRequest C 0..* ServiceRequest A request for a service to be performed
prr-1: orderDetail SHALL only be present if code is present
... 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.

Additional BindingsPurpose
AllLanguages Max Binding
... 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
.... serviceCodeEnd S 0..1 CodeableConcept Extension
URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd
Binding: X12 278 Requested Service Type (required)
.... 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 Identifiers assigned to this order
... instantiatesCanonical Σ 0..* canonical(ActivityDefinition | PlanDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(CarePlan | ServiceRequest | MedicationRequest) What request fulfills
... replaces Σ 0..* Reference(ServiceRequest) What request replaces
... requisition Σ 0..1 Identifier Composite Request ID
... status ?!Σ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): The status of a service order.

... intent ?!SΣ 1..1 code proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Binding: RequestIntent (required): The kind of service request.


Fixed Value: order
... category Σ 0..* CodeableConcept Classification of service
Binding: ServiceRequestCategoryCodes (example): Classification of the requested service.


... priority Σ 0..1 code routine | urgent | asap | stat
Binding: RequestPriority (required): Identifies the level of importance to be assigned to actioning the request.

... doNotPerform ?!Σ 0..1 boolean True if service/procedure should not be performed
... code SΣ 0..1 CodeableConcept What is being requested/ordered
Binding: X12 278 Requested Service Type (required)
... orderDetail ΣC 0..* CodeableConcept Additional order information
Binding: ServiceRequestOrderDetailsCodes (example): Codified order entry details which are based on order context.


... quantity[x] SΣ 0..1 Quantity Service amount
... subject SΣ 1..1 Reference(PAS Beneficiary Patient) Individual or Entity the service is ordered for
... encounter Σ 0..1 Reference(Encounter) Encounter in which the request was created
... occurrence[x] S 0..1 PASTiming A timing schedule that specifies an event that may occur multiple times
... asNeeded[x] Σ 0..1 Preconditions for service
Binding: SNOMEDCTMedicationAsNeededReasonCodes (example): A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

.... asNeededBoolean boolean
.... asNeededCodeableConcept CodeableConcept
... authoredOn Σ 0..1 dateTime Date request signed
... requester Σ 0..1 Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device) Who/what is requesting service
... performerType Σ 0..1 CodeableConcept Performer 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..* Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson) Requested performer
... locationCode Σ 0..* CodeableConcept Requested location
Binding: ServiceDeliveryLocationRoleType (example): A location type where services are delivered.


... locationReference Σ 0..* Reference(Location) Requested location
... reasonCode Σ 0..* CodeableConcept Explanation/Justification for procedure or service
Binding: ProcedureReasonCodes (example): Diagnosis or problem codes justifying the reason for requesting the service investigation.


... reasonReference Σ 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Explanation/Justification for service or service
... insurance 0..* Reference(Coverage | ClaimResponse) Associated insurance coverage
... supportingInfo 0..* Reference(Resource) Additional clinical information
... specimen Σ 0..* Reference(Specimen) Procedure Samples
... bodySite Σ 0..* CodeableConcept Location on Body
Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.


... note 0..* Annotation Comments
... patientInstruction Σ 0..1 string Patient or consumer-oriented instructions
... relevantHistory 0..* Reference(Provenance) Request provenance

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
ServiceRequest.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
ServiceRequest.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status|4.0.1
from the FHIR Standard
ServiceRequest.intentrequiredFixed Value: order
http://hl7.org/fhir/ValueSet/request-intent|4.0.1
from the FHIR Standard
ServiceRequest.categoryexampleServiceRequestCategoryCodes
http://hl7.org/fhir/ValueSet/servicerequest-category
from the FHIR Standard
ServiceRequest.priorityrequiredRequestPriority
http://hl7.org/fhir/ValueSet/request-priority|4.0.1
from the FHIR Standard
ServiceRequest.coderequiredX12278RequestedServiceType
http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType
from this IG
ServiceRequest.orderDetailexampleServiceRequestOrderDetailsCodes
http://hl7.org/fhir/ValueSet/servicerequest-orderdetail
from the FHIR Standard
ServiceRequest.asNeeded[x]exampleSNOMEDCTMedicationAsNeededReasonCodes
http://hl7.org/fhir/ValueSet/medication-as-needed-reason
from the FHIR Standard
ServiceRequest.performerTypeexampleParticipantRoles
http://hl7.org/fhir/ValueSet/participant-role
from the FHIR Standard
ServiceRequest.locationCodeexampleServiceDeliveryLocationRoleType
http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType
ServiceRequest.reasonCodeexampleProcedureReasonCodes
http://hl7.org/fhir/ValueSet/procedure-reason
from the FHIR Standard
ServiceRequest.bodySiteexampleSNOMEDCTBodyStructures
http://hl7.org/fhir/ValueSet/body-site
from the FHIR Standard

 

Other representations of profile: CSV, Excel, Schematron