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 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

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:

• Referral Authorization with Accepted Response
• Homecare Authorization with an Update of the Authorization Request sent as an Full Update and as a Differential Update
• Medical Services Authorization
• Surgical Request Authorization
• Error Response
• Reject Authorization
• Pending Response
• Additional Information Task Example
• Subscription, Subscription Notification, and Claim Inquiry and a Claim Inquiry Response

Guide Artifacts

Here is a listing of the artifacts this guide provides.

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.

Global Profiles

There are no Global profiles defined