Generated Narrative: StructureDefinition PASMetricData Name Flags Card. Type Description & Constraints PASMetricData 0..* Base PAS Metric Data #xD; source 1..1 code provider | intermediary | payer Binding: MetricDataSource (2.2.1) (required) #xD; providerId 1..1 Identifier User invoking hook #xD; system 0..1 uri The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi #xD; value 1..1 string The value that is unique #xD; groupId 1..1 Identifier Healthcare org of user #xD; system 0..1 uri The namespace for the identifier value Required Pattern: http://hl7.org/fhir/sid/us-npi #xD; value 1..1 string The value that is unique #xD; payerId 1..1 Identifier Payer receiving hook #xD; system 1..1 uri The namespace for the identifier value #xD; value 1..1 string The value that is unique #xD; exchange 1..* BackboneElement Prior Authorization Exchanges #xD; type 1..1 code initial | subsequent | cancel | update | query | initialDocToPayer #xD; with 0..1 code provider | intermediary | payer #xD; <a href="StructureDefinition-PASMetricData-definitions.html#PASMetricData.exchange.method" title="Exchange standard used for this specific exchange. Note: RESTful is the default for any Provider to Intermediary exchange, X12 is the defalt for any exchange between the intermediary and the payer for the X12 278, the exchange of the PAS bundle between the intermediary and the payer MAY be any of the methods included in the value set.">method 1..1 code x12 | restful | ihe | direct | other #xD; requestTime 1..1 instant Time exchange initiated #xD; responseTime 0..1 instant Time of exchange response #xD; httpResponse 1..1 code e.g. 200 #xD; issue 0..* BackboneElement OperationOutcome info #xD; code 1..1 code Error code Binding: IssueType (required) #xD; details 0..1 CodeableConcept More detailed error code Binding: OperationOutcomeCodes (example) #xD; aaaCodes 0..* BackboneElement AAA codes returned #xD; loopID 1..1 code see X12 loop IDs #xD; aaaCode 1..1 code approved | modified | denied #xD; itemDetail 0..* BackboneElement Service level item detail #xD; trn 0..1 integer Service Level TRN #xD; item 1..1 CodeableConcept eg. ICD10, HCPCS, NDC #xD; assertionId 0..1 string Unique ID for order item #xD; initialSubmissionTime 0..1 dateTime Date/time of the initial submission of the item #xD; finalResponseTime 0..1 dateTime Date/time of final result #xD; responsesRequired 0..1 integer Number of responses #xD; aaaCodes 0..* BackboneElement AAA codes returned #xD; loopID 1..1 code see X12 loop IDs #xD; aaaCode 1..1 code approved | modified | deined #xD; locationType 0..1 code inpatient | outpatient | home #xD; result 0..1 code approved | modified | denied | pended | cancelled #xD; denialReason 0..1 code Denial Reason #xD; supportingDoc 0..1 url Documentation submitted as part of PAS Bundle #xD; requestedDoc 0..* BackboneElement Documentation requested via 278 response #xD; docRequest 1..* CodeableConcept Coded requests for additional documentation #xD; timeRequested 1..1 dateTime Date/Time of initial request #xD; timeSubmitted 0..1 dateTime Date/Time of final result #xD; submissionMethod 0..1 code CDex | portal | fax | x12 | other #xD; exceptionSubmission 0..1 boolean True if exchange is based on the exception grant #xD; businessLine 0..1 CodeableConcept E.g. MedicareAdvantage #xD; Documentation for this format
HL7 International / Financial Management
A logical model describing the information that ought to be captured by PAS implementers about every PAS invocation to support measures evaluating PAS implementation
A code to indicate which type of system collected the metric data.
The NPI number of the user who initiated the PAS request.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
The NPI of the hospital/clinic/other organization that initiated the PAS request.
The identifier of the payer organization to whom the PAS call was made.
Exchanges between providers, intermediares, and payers to support prior authorization.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
initial | subsequent | cancel | update | query | initialDocToPayer
Exchange standard used for this specific exchange. Note: RESTful is the default for any Provider to Intermediary exchange, X12 is the defalt for any exchange between the intermediary and the payer for the X12 278, the exchange of the PAS bundle between the intermediary and the payer MAY be any of the methods included in the value set.
For providers, the request was made. For payers, the time the request was received. For intermediaries time the request was received from the provider or time the request was sent to the payer.
For providers, the response was received. For payers, the time the response was sent. For intermediaries time the response was sent to the provider or time the response was received from the payer.
What HTTP response code was returned for the exchange invocation.
In the event of an HTTP error, if an OperationOutcome was returned, what were the issues.
The issue.code value from the OperationOutcome for this issue.
The issue.details value from the OperationOutcome for this issue.
Any AAA codes returned during the exchange.
Service level detail. One interation of the backbone for each service item in the PA exchange.
Service level TRN assigned by the payer if a questionnaire is required.
The specific procedure, item, medication, appointment, nutrition that is the subject of the order.
The unique ID for the order item returned by CRD in the coverage information.
Date/time of the initial submission of the item
Date/time of the initial submission of the servcie item. This MAY be the time of the initial PA request or the time of an updated that added the service item.
Date/time that the final result was returned for the specific service item.
Number of responses (initial and any with result pended) for the service item.
AAA error code returned in the response.
The site where the service will be performed.
approved | modified | denied | pended | cancelled
Final result of the specific service item.
A code specifying the reason why the item was denied.
Documentation submitted as part of PAS Bundle
The URL of the questionnaire that was the basis for the questionnaireResponse submitted as part of the PAS bundle for the specific service item.
Documentation requested via 278 response
Documentation requested via 278 response.
Coded requests for additional documentation
Coded requests for documentation in the 278 response. May be LOINC codes as determined by HIPAA tab or X12 codes from the PWK01 element.
Date/Time of initial request for this item (MAY be part of the initial submission or part an update.
Date/Time of final result for this item (MAY be part of the initial submission or part an update.
The technical method used to submit the requested additional documentation.
True if exchange is based on the exception grant
Indicator that exchange was performed under an exception grant from the National Standard Group.
A code that indicates which type of insurance the patient is covered by.