Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0-preview - STU 2 United States of America flag

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 2.1.0-preview 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

Artifacts Overview

Page standards status: Informative

Previous Page - Credits

Complying with this implementation guide means complying with a number of profiles, extensions, value sets and custom search parameters. This page provides an overview of where this information can be found.

These FHIR artifacts define the clinical data that can be submitted as part of a prior authorization submission and/or included as part of a prior authorization response using the Claim submit operation.

The artifacts are of four types:

  • Profiles constrain FHIR resources to reflect PAS requirements
  • Extensions define additional data elements that can be conveyed as part of a resource
  • Code Systems define PAS-specific terminologies to be used in one or more of those profiles
  • Value Sets define the specific subsets of both PAS-defined and other code systems that can be (or are recommended to be) used within one or more profile elements
  • Operations which define the PAS-specific constraints on the Claim submit operation as well as a Claim inquiry operation.

Many of the profiles are based on US Core 7.0.0 while also declaring conformance with US Core 6.1.0 and 3.1.1. In some cases, the 7.0.0 and/or 6.1.0 releases introduce new "mustSupport" elements that are not mustSupport in 3.1.1. The intention of this implementation guide is NOT to move forward the timelines by which EHRs and/or payers must support USCDI 3 and 4 content. Rather, it is to allow seamless transition as systems start to support the newer US Core releases as systems start to bring them on stream. As such, clients and servers have no obligations with respect to elements that are newly mustSupport in 6.1.0 or 7.0.0 beyond "don't error if these elements are present" until such time as those systems claim conformance with the US Core release which introduces those elements as mustSupport. Once a system claims conformance to US Core 6.1.0 or 7.0.0, then the conformance expectations of those release of the US Core guide come into play.

Guide Examples

The following examples are present in this guide to show specific use cases:

Artifact Lists

FHIR PAS-specific Artifacts
US Core

Additional information about the use of these artifacts can be found in the main specification.

Cross-Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.davinci-pas.r4) and R4B (hl7.fhir.us.davinci-pas.r4b) are available.

Intellectual Property Statements

This publication includes IP covered under the following statements.

Global Profiles

There are no Global profiles defined

IG Dependencies

This IG Contains the following dependencies on other IGs.

IGPackageFHIRComment
.. Da Vinci Prior Authorization Support (PAS) FHIR IGhl7.fhir.us.davinci-pas#2.1.0-previewR4
... HL7 Terminology (THO)hl7.terminology.r4#6.0.2R4Automatically added as a dependency - all IGs depend on HL7 Terminology
... FHIR Extensions Packhl7.fhir.uv.extensions.r4#5.1.0R4Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
... US Core (Reuse Wrapper)hl7.fhir.us.core.v311#3.1.1R4
.... US Corehl7.fhir.us.core#3.1.1R4
... US Core Implementation Guidehl7.fhir.us.core#6.1.0R4
.... HL7 Terminology (THO)hl7.terminology.r4#5.0.0R4
.... FHIR Extensions Packhl7.fhir.uv.extensions.r4#1.0.0R4
.... Bulk Data Access IGhl7.fhir.uv.bulkdata#2.0.0R4
.... SMART App Launchhl7.fhir.uv.smart-app-launch#2.1.0R4
.... VSACus.nlm.vsac#0.11.0R4
.... Structured Data Capturehl7.fhir.uv.sdc#3.0.0R4
.... PHINVadsus.cdc.phinvads#0.12.0R4
.... IHE FormatCode Vocabularyihe.formatcode.fhir#1.1.0R4
... US Core (Reuse Wrapper)hl7.fhir.us.core.v700#7.0.0R4
.... US Core Implementation Guidehl7.fhir.us.core#7.0.0R4
..... HL7 Terminology (THO)hl7.terminology.r4#5.5.0R4
..... SMART App Launchhl7.fhir.uv.smart-app-launch#2.0.0R4
..... VSACus.nlm.vsac#0.18.0R4
... Da Vinci - Coverage Requirements Discoveryhl7.fhir.us.davinci-crd#2.0.0R4
.... HL7 Terminology (THO)hl7.terminology.r4#5.3.0R4
.... Da Vinci Health Record Exchange (HRex)hl7.fhir.us.davinci-hrex#1.0.0R4
..... Security for Scalable Registration, Authentication, and Authorizationhl7.fhir.us.udap-security#0.1.0R4
... Subscriptions R5 Backporthl7.fhir.uv.subscriptions-backport.r4#1.1.0R4
... CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)hl7.fhir.us.carin-bb#2.0.0R4
.... VSACus.nlm.vsac#0.7.0R4

Package hl7.fhir.uv.extensions.r4#5.1.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.uv.extensions.r4#1.0.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.uv.bulkdata#2.0.0

FHIR based approach for exporting large data sets from a FHIR server to a client application (built Fri, Nov 26, 2021 05:56+1100+11:00)

Package hl7.fhir.uv.sdc#3.0.0

The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR.
This includes two components:
* Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains.
*Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)

Package ihe.formatcode.fhir#1.1.0

Implementation Guide for IHE defined FormatCode vocabulary. (built Thu, Feb 24, 2022 16:55-0600-06:00)

Package hl7.fhir.us.core#6.1.0

The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Fri, Jun 30, 2023 14:02+0000+00:00)

Package hl7.fhir.us.core#7.0.0

The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Wed, May 8, 2024 15:33+0000+00:00)

Package hl7.fhir.us.udap-security#0.1.0

This implementation guide describes how to extend OAuth 2.0 to support secure and scalable workflows for business-to-business (B2B) apps that implement the client credentials flow or authorization code flow. (built Fri, Aug 6, 2021 15:57+0000+00:00)

Package hl7.fhir.us.davinci-hrex#1.0.0

The Da Vinci Payer Health Record exchange (HRex) Framework/library specifies the FHIR elements used in multiple Da Vinci implementation guides. This includes FHIR profiles, functions, operations, and constraints on other specifications such as CDS-Hooks and other aspects of Da Vinci Use Cases that are common across more than a single use case.

Da Vinci HRex Implementation Guide (IG) will make use of US Core profiles that are based on the FHIR R4 specification wherever practical. The HRex IG will use the HL7 FHIR Release 4/US Core STU3 specification as its base but will provide additional guidance and documentation to support implementations that follow the HL7 FHIR STU3/US Core STU2 and HL7 FHIR DSTU2/Argonaut specifications.

The HRex profiles documented in this IG will be used to exchange data between providers systems (e.g. EHRs) and other providers, payers, and third-party applications where appropriate. In addition, exchanges from payer systems to providers, other payers, and third-party applications are supported by the HRex profiles and operations.

HRex may define new extensions, profiles, value sets, constraints/extension to other specification (e.g. specific CDS-Hooks) that are specific Da Vinci requirements. Where appropriate these Da Vinci specific artifacts will be promoted for incorporation into the future versions of existing standards (e.g. R4 US Core profiles) and deprecated in this guide on publication in the updated standard. (built Wed, Mar 23, 2022 18:55+0000+00:00)

Package hl7.fhir.us.davinci-crd#2.0.0

Guidelines for conveying coverage requirements to clinicians when planning treatment (built Fri, Oct 20, 2023 14:17+0000+00:00)

Package hl7.fhir.uv.subscriptions-backport.r4#1.1.0

The Subscription R5 Backport Implementation Guide enables servers running versions of FHIR earlier than R5 to implement a subset of R5 Subscriptions in a standardized way. (built Wed, Jan 11, 2023 15:34+1100+11:00)

Package hl7.fhir.us.carin-bb#2.0.0

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) (built Mon, Nov 28, 2022 15:15+0000+00:00)