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 2.2.1 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

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: Submit a Prior Authorization Request for adjudication

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/OperationDefinition/Claim-submit> a fhir:OperationDefinition ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "Claim-submit"] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: OperationDefinition Claim-submit</b></p><a name=\"Claim-submit\"> </a><a name=\"hcClaim-submit\"> </a><p>URL: [base]/Claim/$submit</p><h3>Parameters</h3><table class=\"grid\"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>resource</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/bundle.html\">Bundle</a> (<a href=\"StructureDefinition-profile-pas-request-bundle.html\" title=\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1\">PAS Request Bundle</a>)</td><td/><td><div><p>A Bundle containing a single Claim plus referenced resources.</p>\n</div></td></tr><tr><td>OUT</td><td>return</td><td/><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/bundle.html\">Bundle</a> (<a href=\"StructureDefinition-profile-pas-response-bundle.html\" title=\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1\">PAS Response Bundle</a>)</td><td/><td><div><p>A Bundle containing a single ClaimResponse plus referenced resources.</p>\n</div></td></tr></table></div>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
     fhir:Extension.valueCode [ fhir:value "fm" ]
  ], [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm" ] ;
     fhir:Extension.valueInteger [
       fhir:value "4"^^xsd:integer ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
         fhir:Extension.valueCanonical [
           fhir:value "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas" ;
           fhir:link <http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas>
         ]
       ]
     ]
  ], [
     fhir:index -1 ;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
     fhir:Extension.valueCode [
       fhir:value "trial-use" ;
       fhir:Element.extension [
         fhir:index -1 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
         fhir:Extension.valueCanonical [
           fhir:value "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas" ;
           fhir:link <http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas>
         ]
       ]
     ]
  ] ;
  fhir:OperationDefinition.url [ fhir:value "http://hl7.org/fhir/us/davinci-pas/OperationDefinition/Claim-submit"] ;
  fhir:OperationDefinition.version [ fhir:value "2.2.1"] ;
  fhir:OperationDefinition.name [ fhir:value "ClaimSubmit"] ;
  fhir:OperationDefinition.title [ fhir:value "Submit a Prior Authorization Request for adjudication"] ;
  fhir:OperationDefinition.status [ fhir:value "draft"] ;
  fhir:OperationDefinition.kind [ fhir:value "operation"] ;
  fhir:OperationDefinition.date [ fhir:value "2026-08-28T19:31:09+00:00"^^xsd:dateTime] ;
  fhir:OperationDefinition.publisher [ fhir:value "HL7 International / Financial Management"] ;
  fhir:OperationDefinition.contact [
     fhir:index -1 ;
     fhir:ContactDetail.name [ fhir:value "HL7 International / Financial Management" ] ;
     fhir:ContactDetail.telecom [
       fhir:index -1 ;
       fhir:ContactPoint.system [ fhir:value "url" ] ;
       fhir:ContactPoint.value [ fhir:value "http://hl7.org/Special/committees/fm" ]
     ], [
       fhir:index -1 ;
       fhir:ContactPoint.system [ fhir:value "email" ] ;
       fhir:ContactPoint.value [ fhir:value "fmlists@lists.hl7.org" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ContactDetail.name [ fhir:value "Jean Duteau" ] ;
     fhir:ContactDetail.telecom [
       fhir:index -1 ;
       fhir:ContactPoint.system [ fhir:value "email" ] ;
       fhir:ContactPoint.value [ fhir:value "mailto:jean@duteaudesign.com" ]
     ]
  ], [
     fhir:index -1 ;
     fhir:ContactDetail.name [ fhir:value "HL7 International / Financial Management" ] ;
     fhir:ContactDetail.telecom [
       fhir:index -1 ;
       fhir:ContactPoint.system [ fhir:value "url" ] ;
       fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/fm" ]
     ]
  ] ;
  fhir:OperationDefinition.description [ fhir:value "This operation is used to submit a PreAuthorization Claim Request for adjudication as a Bundle containing the PASClaimRequest and other referenced resources for processing. The only input parameter is the single Bundle resource with a PASClaimRequest instance (along with other referenced resources) and the only output is a single Bundle with a PASClaimResponse (and other referenced resources) or an OperationOutcome resource.  This is a variant of the FHIR Core Claim $submit operation."] ;
  fhir:OperationDefinition.jurisdiction [
     fhir:index -1 ;
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
       fhir:Coding.code [ fhir:value "US" ] ;
       fhir:Coding.display [ fhir:value "United States of America" ]
     ]
  ] ;
  fhir:OperationDefinition.code [ fhir:value "submit"] ;
  fhir:OperationDefinition.base [
     fhir:value "http://hl7.org/fhir/OperationDefinition/Claim-submit" ;
     fhir:link <http://hl7.org/fhir/OperationDefinition/Claim-submit>
  ] ;
  fhir:OperationDefinition.resource [
     fhir:value "Claim" ;
     fhir:index -1
  ] ;
  fhir:OperationDefinition.system [ fhir:value "false"^^xsd:boolean] ;
  fhir:OperationDefinition.type [ fhir:value "true"^^xsd:boolean] ;
  fhir:OperationDefinition.instance [ fhir:value "false"^^xsd:boolean] ;
  fhir:OperationDefinition.parameter [
     fhir:index -1 ;
     fhir:OperationDefinition.parameter.name [ fhir:value "resource" ] ;
     fhir:OperationDefinition.parameter.use [ fhir:value "in" ] ;
     fhir:OperationDefinition.parameter.min [ fhir:value "1"^^xsd:integer ] ;
     fhir:OperationDefinition.parameter.max [ fhir:value "1" ] ;
     fhir:OperationDefinition.parameter.documentation [ fhir:value "A Bundle containing a single Claim plus referenced resources." ] ;
     fhir:OperationDefinition.parameter.type [ fhir:value "Bundle" ] ;
     fhir:OperationDefinition.parameter.targetProfile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle|2.2.1>
     ]
  ], [
     fhir:index -1 ;
     fhir:OperationDefinition.parameter.name [ fhir:value "return" ] ;
     fhir:OperationDefinition.parameter.use [ fhir:value "out" ] ;
     fhir:OperationDefinition.parameter.min [ fhir:value "1"^^xsd:integer ] ;
     fhir:OperationDefinition.parameter.max [ fhir:value "1" ] ;
     fhir:OperationDefinition.parameter.documentation [ fhir:value "A Bundle containing a single ClaimResponse plus referenced resources." ] ;
     fhir:OperationDefinition.parameter.type [ fhir:value "Bundle" ] ;
     fhir:OperationDefinition.parameter.targetProfile [
       fhir:value "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1" ;
       fhir:index -1 ;
       fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-response-bundle|2.2.1>
     ]
  ] .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/OperationDefinition/Claim-submit.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/OperationDefinition/Claim-submit.ttl> .