Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

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 2.2.0-ballot 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

## Extension: ItemAuthorizedDetail

Official URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail | Version: 2.2.0-ballot
Standards status: Trial-use | Maturity Level: 3 | Computable Name: ItemAuthorizedDetail
Other Identifiers: OID:2.16.840.1.113883.4.642.40.24.42.19

The details of what has been authorized for this item.

Context of Use

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

- Element ID: `ExplanationOfBenefit`
- Element ID: `ExplanationOfBenefit.item`
- Element ID: `ClaimResponse.item`

Usage info

Usages:

- Use this Extension: PAS Claim Response Base
- Examples for this Extension: Bundle/PASSubscriptionNotification, Bundle/ReferralAuthorizationResponseBundleExample, ClaimResponse/PractitionerRequestorAdditionalContentResponseExample and ClaimResponse/PractitionerRequestorResponseExample

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

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

- 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 | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:productOrServiceCode |  | 0..1 | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Type (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier |  | 0..* | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice |  | 0..1 | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. 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:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHA NUBC Revenue Value Set (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
value[x] |  | 0..0 |  |
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:productOrServiceCode |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Type (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. 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:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHA NUBC Revenue Value Set (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The details of what has been authorized for this item.

- productOrServiceCode: CodeableConcept: An Extension
- modifier: CodeableConcept: An Extension
- unitPrice: Money: An Extension
- quantity: Quantity: An Extension

Maturity: 3

Differential View

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:productOrServiceCode |  | 0..1 | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Type (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier |  | 0..* | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice |  | 0..1 | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
extension |  | 0..0 |  |
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. 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:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHA NUBC Revenue Value Set (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
value[x] |  | 0..0 |  |
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:productOrServiceCode |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "productOrServiceCode"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Type (required)
extension:productOrServiceCodeEnd |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd Binding: X12 278 Requested Service Type (required)
extension:modifier |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "modifier"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: X12 278 Requested Service Modifier Type (required)
extension:unitPrice |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "unitPrice"
value[x] |  | 0..1 | Money | Value of extension
extension:quantity |  | 0..1 | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "quantity"
value[x] |  | 0..1 | PASQuantity | Value of extension
extension:epsdtIndicator |  | 0..1 | boolean | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator
extension:nursingHomeLevelOfCare |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare Binding: https://valueset.x12.org/x217/005010/request/2000F/SV1/1/20/00/1337 (required): Codes specifying the level of care provided by a nursing home facility. 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:revenue |  | 0..1 | CodeableConcept | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueCode Binding: AHA NUBC Revenue Value Set (required)
extension:revenueUnitRateLimit |  | 0..1 | decimal | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit
extension:authorizedService |  | 0..1 | Reference(PAS Medication Request | PAS Service Request | PAS Device Request | PAS Nutrition Order) | Extension URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService
url |  | 1..1 | uri | "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemAuthorizedDetail"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: The details of what has been authorized for this item.

- productOrServiceCode: CodeableConcept: An Extension
- modifier: CodeableConcept: An Extension
- unitPrice: Money: An Extension
- quantity: Quantity: An Extension

Maturity: 3

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Extension.extension:productOrServiceCode.value[x] | required | X12278RequestedServiceType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceType` From this IG
Extension.extension:modifier.value[x] | required | X12278RequestedServiceModifierType `http://hl7.org/fhir/us/davinci-pas/ValueSet/X12278RequestedServiceModifierType` From this IG

#### Constraints

Id | Grade | Path(s) | Details | Requirements
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |