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: Claim Response Reviewer

Context of Use

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

• Element ID: ClaimResponse

Usage info

Usages:

• Use this Extension: PAS Claim Response Base
• Examples for this Extension: Bundle/RejectionResponseBundleExample and ClaimResponse/RejectionResponseExample

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	Claim Response Reviewer
Extension.extension		1..*	Extension	Extension
Extension.Slices for extension				Content/Rules for all slices
Extension.Slices for extension.extension:wasHumanReviewedFlag		1..1	Extension	Extension
Extension.Slices for extension.extension:wasHumanReviewedFlag.extension		0..0		Extension
Extension.Slices for extension.extension:wasHumanReviewedFlag.url		1..1	uri	"wasHumanReviewedFlag"
Extension.Slices for extension.extension:wasHumanReviewedFlag.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:reviewerNPI		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerNPI.extension		0..0		Extension
Extension.Slices for extension.extension:reviewerNPI.url		1..1	uri	"reviewerNPI"
Extension.Slices for extension.extension:reviewerNPI.value[x]		0..1	PASIdentifier(2.2.1)	Value of extension
Extension.Slices for extension.extension:reviewerSpecialty		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerSpecialty.extension		0..0		Extension
Extension.Slices for extension.extension:reviewerSpecialty.url		1..1	uri	"reviewerSpecialty"
Extension.Slices for extension.extension:reviewerSpecialty.value[x]		0..1	CodeableConcept	Value of extension Binding: HealthcareProviderTaxonomy (20240606) (extensible)
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer"
Extension.value[x]		0..0		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reviewerSpecialty.​value[x]	Base	extensible	Healthcare Provider Taxonomy	📍20240606	VSAC v0.19

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Claim Response Reviewer
Extension.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension		1..*	Extension	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:wasHumanReviewedFlag		1..1	Extension	Extension
Extension.Slices for extension.extension:wasHumanReviewedFlag.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:wasHumanReviewedFlag.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:wasHumanReviewedFlag.url		1..1	uri	"wasHumanReviewedFlag"
Extension.Slices for extension.extension:wasHumanReviewedFlag.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:reviewerNPI		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerNPI.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:reviewerNPI.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:reviewerNPI.url		1..1	uri	"reviewerNPI"
Extension.Slices for extension.extension:reviewerNPI.value[x]		0..1	PASIdentifier(2.2.1)	Value of extension
Extension.Slices for extension.extension:reviewerSpecialty		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerSpecialty.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:reviewerSpecialty.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:reviewerSpecialty.url		1..1	uri	"reviewerSpecialty"
Extension.Slices for extension.extension:reviewerSpecialty.value[x]		0..1	CodeableConcept	Value of extension Binding: HealthcareProviderTaxonomy (20240606) (extensible)
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reviewerSpecialty.​value[x]	Base	extensible	Healthcare Provider Taxonomy	📍20240606	VSAC v0.19

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Extension

Summary

Complex Extension: The responsible practitioner who reviewed to the request.

• wasHumanReviewedFlag: boolean: An Extension
• reviewerNPI: Identifier: An Extension
• reviewerSpecialty: CodeableConcept: 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	Claim Response Reviewer
Extension.extension		1..*	Extension	Extension
Extension.Slices for extension				Content/Rules for all slices
Extension.Slices for extension.extension:wasHumanReviewedFlag		1..1	Extension	Extension
Extension.Slices for extension.extension:wasHumanReviewedFlag.extension		0..0		Extension
Extension.Slices for extension.extension:wasHumanReviewedFlag.url		1..1	uri	"wasHumanReviewedFlag"
Extension.Slices for extension.extension:wasHumanReviewedFlag.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:reviewerNPI		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerNPI.extension		0..0		Extension
Extension.Slices for extension.extension:reviewerNPI.url		1..1	uri	"reviewerNPI"
Extension.Slices for extension.extension:reviewerNPI.value[x]		0..1	PASIdentifier(2.2.1)	Value of extension
Extension.Slices for extension.extension:reviewerSpecialty		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerSpecialty.extension		0..0		Extension
Extension.Slices for extension.extension:reviewerSpecialty.url		1..1	uri	"reviewerSpecialty"
Extension.Slices for extension.extension:reviewerSpecialty.value[x]		0..1	CodeableConcept	Value of extension Binding: HealthcareProviderTaxonomy (20240606) (extensible)
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer"
Extension.value[x]		0..0		Value of extension
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reviewerSpecialty.​value[x]	Base	extensible	Healthcare Provider Taxonomy	📍20240606	VSAC v0.19

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Extension		0..*	Extension	Claim Response Reviewer
Extension.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension		1..*	Extension	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:wasHumanReviewedFlag		1..1	Extension	Extension
Extension.Slices for extension.extension:wasHumanReviewedFlag.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:wasHumanReviewedFlag.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:wasHumanReviewedFlag.url		1..1	uri	"wasHumanReviewedFlag"
Extension.Slices for extension.extension:wasHumanReviewedFlag.value[x]		0..1	boolean	Value of extension
Extension.Slices for extension.extension:reviewerNPI		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerNPI.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:reviewerNPI.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:reviewerNPI.url		1..1	uri	"reviewerNPI"
Extension.Slices for extension.extension:reviewerNPI.value[x]		0..1	PASIdentifier(2.2.1)	Value of extension
Extension.Slices for extension.extension:reviewerSpecialty		0..1	Extension	Extension
Extension.Slices for extension.extension:reviewerSpecialty.id		0..1	string	Unique id for inter-element referencing
Extension.Slices for extension.extension:reviewerSpecialty.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:reviewerSpecialty.url		1..1	uri	"reviewerSpecialty"
Extension.Slices for extension.extension:reviewerSpecialty.value[x]		0..1	CodeableConcept	Value of extension Binding: HealthcareProviderTaxonomy (20240606) (extensible)
Extension.url		1..1	uri	"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-claimResponseReviewer"
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Extension.extension:reviewerSpecialty.​value[x]	Base	extensible	Healthcare Provider Taxonomy	📍20240606	VSAC v0.19

Constraints

Id

Grade

Path(s)

Description

Expression

This structure is derived from Extension

Summary

Complex Extension: The responsible practitioner who reviewed to the request.

• wasHumanReviewedFlag: boolean: An Extension
• reviewerNPI: Identifier: An Extension
• reviewerSpecialty: CodeableConcept: An Extension

Maturity: 4

Other representations of profile: CSV, Excel, Schematron