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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Extension: Review Action

Context of Use

This extension may be used on the following element(s)

• Element ID: ClaimResponse.adjudication
• Element ID: ClaimResponse.item.adjudication
• Element ID: ClaimResponse.addItem.adjudication

Usage info

Usages:

• Use this Extension: PAS Claim Response Base and PAS Claim Response Base
• Examples for this Extension: Bundle/PASClaimInquiryResponseBundleExample, Bundle/PASSubscriptionNotification, Bundle/ReferralAuthorizationResponseBundleExample, Bundle/ReferralPendingAuthorizationResponseBundleExample... Show 7 more, Bundle/RejectionResponseBundleExample, ClaimResponse/PASClaimInquiryResponseExample, ClaimResponse/PractitionerRequestorAdditionalContentResponseExample, ClaimResponse/PractitionerRequestorPendingResponseExample, ClaimResponse/PractitionerRequestorResponseExample, ClaimResponse/RejectionResponseExample and Parameters/PASClaimInquiryOperationResponseExample

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

• Differential Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Extension

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action
Extension.Slices for extension				Content/Rules for all slices
Extension.Slices for extension.extension:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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.
Extension.Slices for extension.extension:number		0..1	Extension	Item Level Review Number
Extension.Slices for extension.extension:number.extension		0..0		Extension
Extension.Slices for extension.extension:number.url		1..1	uri	"number"
Extension.Slices for extension.extension:number.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
Extension.Slices for extension.extension:reasonCode.extension		0..0		Extension
Extension.Slices for extension.extension:reasonCode.url		1..1	uri	"reasonCode"
Extension.Slices for extension.extension:reasonCode.value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.1) (required)
Extension.Slices for extension.extension:secondSurgicalOpinionFlag		0..1	Extension	Whether a second surgical opinion is need for approval
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.extension		0..0		Extension
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.url		1..1	uri	"secondSurgicalOpinionFlag"
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.value[x]		0..1	boolean	Value of extension
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
Extension.value[x]		0..0		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍2.2.1	This IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action
Extension.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Extension.Slices for extension.extension:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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.
Extension.Slices for extension.extension:number		0..1	Extension	Item Level Review Number
Extension.Slices for extension.extension:number.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:number.extension		0..0		Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:number.url		1..1	uri	"number"
Extension.Slices for extension.extension:number.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
Extension.Slices for extension.extension:reasonCode.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:reasonCode.extension		0..0		Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:reasonCode.url		1..1	uri	"reasonCode"
Extension.Slices for extension.extension:reasonCode.value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.1) (required)
Extension.Slices for extension.extension:secondSurgicalOpinionFlag		0..1	Extension	Whether a second surgical opinion is need for approval
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.extension		0..0		Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.url		1..1	uri	"secondSurgicalOpinionFlag"
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.value[x]		0..1	boolean	Value of extension
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍2.2.1	This IG

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Extension

Summary

Complex Extension: The details of the review action that is necessary for the authorization.

• number: string: An Extension
• reasonCode: CodeableConcept: An Extension
• secondSurgicalOpinionFlag: boolean: An Extension

Maturity: 4

Differential View

This structure is derived from Extension

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action
Extension.Slices for extension				Content/Rules for all slices
Extension.Slices for extension.extension:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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.
Extension.Slices for extension.extension:number		0..1	Extension	Item Level Review Number
Extension.Slices for extension.extension:number.extension		0..0		Extension
Extension.Slices for extension.extension:number.url		1..1	uri	"number"
Extension.Slices for extension.extension:number.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
Extension.Slices for extension.extension:reasonCode.extension		0..0		Extension
Extension.Slices for extension.extension:reasonCode.url		1..1	uri	"reasonCode"
Extension.Slices for extension.extension:reasonCode.value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.1) (required)
Extension.Slices for extension.extension:secondSurgicalOpinionFlag		0..1	Extension	Whether a second surgical opinion is need for approval
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.extension		0..0		Extension
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.url		1..1	uri	"secondSurgicalOpinionFlag"
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.value[x]		0..1	boolean	Value of extension
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
Extension.value[x]		0..0		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍2.2.1	This IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Review Action
Extension.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Extension.Slices for extension.extension:code		0..1	CodeableConcept	Healthcare Services Outcome URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode Binding: https://valueset.x12.org/x217/005010/response/2000F/HCR/1/01/00/306 (required): Codes indicating type of action. 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.
Extension.Slices for extension.extension:number		0..1	Extension	Item Level Review Number
Extension.Slices for extension.extension:number.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:number.extension		0..0		Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:number.url		1..1	uri	"number"
Extension.Slices for extension.extension:number.value[x]		0..1	string	Value of extension
Extension.Slices for extension.extension:reasonCode		0..*	Extension	Certification Action Code: indicates the reason for the approved, denied, or pended services
Extension.Slices for extension.extension:reasonCode.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:reasonCode.extension		0..0		Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:reasonCode.url		1..1	uri	"reasonCode"
Extension.Slices for extension.extension:reasonCode.value[x]		0..1	CodeableConcept	Value of extension Binding: X12278ReviewDecisionReasonCode (2.2.1) (required)
Extension.Slices for extension.extension:secondSurgicalOpinionFlag		0..1	Extension	Whether a second surgical opinion is need for approval
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.extension		0..0		Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.url		1..1	uri	"secondSurgicalOpinionFlag"
Extension.Slices for extension.extension:secondSurgicalOpinionFlag.value[x]		0..1	boolean	Value of extension
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewAction"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reasonCode.​value[x]	Base	required	X12 278 Review Decision Reason Codes	📍2.2.1	This IG

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Extension

Summary

Complex Extension: The details of the review action that is necessary for the authorization.

• number: string: An Extension
• reasonCode: CodeableConcept: An Extension
• secondSurgicalOpinionFlag: boolean: An Extension

Maturity: 4

Other representations of profile: CSV, Excel, Schematron